Healthcare Provider Details

I. General information

NPI: 1548855406
Provider Name (Legal Business Name): ACCREDO HEALTH GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E SUNSET RD STE J
LAS VEGAS NV
89119-4935
US

IV. Provider business mailing address

PO BOX 954041
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-8990
  • Fax:
Mailing address:
  • Phone: 901-381-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTOR JOSEPH PERINI
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 314-684-6750