Healthcare Provider Details

I. General information

NPI: 1417209438
Provider Name (Legal Business Name): OPTUM INFUSION SERVICES 401, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 NORTHGATE BLVD STE. 130
SACRAMENTO CA
95834-1122
US

IV. Provider business mailing address

1 OPTUM CIR STE 100
EDEN PRAIRIE MN
55344-2956
US

V. Phone/Fax

Practice location:
  • Phone: 877-698-5415
  • Fax: 844-425-0128
Mailing address:
  • Phone: 800-328-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENISE MCCABE
Title or Position: SECRETARY
Credential:
Phone: 952-935-1191