Healthcare Provider Details

I. General information

NPI: 1588330088
Provider Name (Legal Business Name): OPTUM PHARMACY 701, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 S HORNE
MESA AZ
85204-5771
US

IV. Provider business mailing address

1 OPTUM CIR STE 100
EDEN PRAIRIE MN
55344-2503
US

V. Phone/Fax

Practice location:
  • Phone: 877-719-6349
  • Fax: 877-719-6362
Mailing address:
  • Phone: 800-328-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN EUGENE BURR
Title or Position: SECRETARY
Credential:
Phone: 712-310-4701