Healthcare Provider Details

I. General information

NPI: 1184675910
Provider Name (Legal Business Name): ACCREDO HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W GRAND AVE STE 102
ELMHURST IL
60126-1043
US

IV. Provider business mailing address

PO BOX 954041
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-279-7390
  • Fax: 630-279-8464
Mailing address:
  • Phone: 901-381-7141
  • Fax: 901-261-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054013616
License Number StateIL

VIII. Authorized Official

Name: VIC PERINI
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 314-684-6273