MEDICARE: OPTUM PHARMACY 706, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1295842615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM PHARMACY 706, INC.

Provider Business Mailing Address
First Line	:	1 OPTUM CIR STE 100
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2503
Country	:	US
Telephone Number	:	800-328-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 47TH AVE STE 410
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3433
Country	:	US
Telephone Number	:	866-903-4466
Fax Number	:	718-391-0777

Authorized Official
Title or Position	:	SECRETARY
Name	:	KEVIN EUGENE BURR
Credential	:
Telephone Number	:	712-310-4701

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/04/2024

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