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	5301006495	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2043485	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710933007
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	:	39625 LEWIS DR
Second Line	:	STE 800
City	:	NOVI
State	:	MI
Zip	:	48377-2972
Country	:	US
Telephone Number	:	248-489-0300
Fax Number	:	248-489-1126

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/06/2026

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Directions to “ACCREDO HEALTH GROUP INC ” Practice Location

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