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General NPI Number Information
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NPI Number | 1063572295
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Entity Type | Organization
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Legal Business Name | OPTUMCARE FLORIDA, LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 4757 US HIGHWAY 19
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4945
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Country | US
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Telephone | 727-849-9373
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Fax | 727-841-0497
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Provider Business Mailing Address
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Address Line | 10051 5TH STREET NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33702-2299
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Country | US
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Telephone | 727-849-9373
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Fax | 727-841-0497
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN G. LIETHEN
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Credential |
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Telephone | 952-205-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH18603
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License Number State | FL
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