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General NPI Number Information
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NPI Number | 1326846585
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Entity Type | Organization
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Legal Business Name | OPTUM PHARMACY 702, LLC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1050 PATROL RD
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-7750
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Country | US
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Telephone | 855-427-4682
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Fax | 877-223-1603
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Provider Business Mailing Address
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Address Line | 1 OPTUM CIR STE 100
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 800-328-5979
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | KEVIN EUGENE BURR
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Credential |
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Telephone | 712-310-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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