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General NPI Number Information
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NPI Number | 1558681460
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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 | 06/03/2010
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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 STE A
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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 | 727-815-1203
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Provider Business Mailing Address
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Address Line | 4757 US HIGHWAY 19 SUITE A
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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 | 727-815-1203
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH24634
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License Number State | FL
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