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General NPI Number Information
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NPI Number | 1376246942
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Entity Type | Organization
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Legal Business Name | OPTUMRX PHARMACY OF NEVADA, INC.
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 6350 SOUTH DURANGO DR
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 725-233-2100
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Fax | 725-223-2110
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Provider Business Mailing Address
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Address Line | 6350 DURANGO DR
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 844-231-9072
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Fax | 844-265-0611
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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 | 333600000X
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Taxonomy Name | 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 |
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License Number State |
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