Healthcare Provider Details

I. General information

NPI: 1114097292
Provider Name (Legal Business Name): OPTUM CARE WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 106TH ST SW
MUKILTEO WA
98275-4700
US

IV. Provider business mailing address

PO BOX 2747
EVERETT WA
98213-0747
US

V. Phone/Fax

Practice location:
  • Phone: 425-493-6005
  • Fax: 425-493-6035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00056689
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE GO
Title or Position: BOARD PRESIDENT
Credential: M.D.
Phone: 425-258-3900