MEDICARE: ACCREDO HEALTH GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy
5	333600000X	Pharmacy	PHRE007812	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2019054	OTHER	PK

General Provider Information

NPI Number	:	1205884483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCREDO HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 954041
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0001
Country	:	US
Telephone Number	:	901-381-7141
Fax Number	:	901-261-6924

Provider Business Practice Location Address
First Line	:	190 TECHNOLOGY PKWY STE 120
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2914
Country	:	US
Telephone Number	:	770-935-2510
Fax Number	:	800-554-5545

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	VICTOR JOSEPH PERINI
Credential	:
Telephone Number	:	314-847-0146

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/06/2026

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Directions to “ACCREDO HEALTH GROUP INC ” Practice Location

Language	Start Address	Practice Location

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