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DAVITA MEDICAL GROUP, PHARMACY
NPI 1245390475
Pharmacy - Community/Retail Pharmacy in Tampa, FL

Active since December 11, 2006CLIA Certified · 4 labs
3665 W WATERS AVE, TAMPA, FL 33614(813) 935-6431(813) 915-0741 Get Directions Write a Review

NPPES record last updated: August 20, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 20, 2019, Jul 21, 2017 (2 updates tracked since 2017).

About Davita Medical Group, Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVITA MEDICAL GROUP, PHARMACY (NPI 1245390475) is a healthcare organization registered as a community/retail pharmacy in Tampa, Florida and active in the NPI registry since December 2006. The organization holds 4 active CLIA laboratory certificates and lists John G. Liethen, Secretary, as its authorized official.

NPPES Registry Identity

NPI1245390475
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameOPTUMCARE FLORIDA, LLC
Location Address3665 W WATERS AVETampa, FL 33614-2783
Mailing Address10051 5th St. NSt. Petersburg, FL 33702-2289 · (727) 828-2314
Phone(813) 935-6431
Fax(813) 915-0741
Organization SubpartNo
Authorized OfficialJohn G. LiethenSecretary · (952) 205-6262
Enumeration DateDecember 11, 2006
Last NPPES UpdateAugust 20, 20192 updates tracked since enumeration
✔ NPI 1245390475 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in FL · PH18512
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedPharmacyTaxonomy 333600000X
3665 W WATERS AVE, Tampa, FL 33614
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Other Names 1

Doing Business AsDavita Medical Group, Pharmacy

Other Identifiers 3

Other2014551Pk
Medicaid4399230005FL
Medicaid030842100FL

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0932062

Optumcare Florida LLC · Tampa, FL
Active · expires Aug 11, 2027
CLIA Number10D0932062
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2025
Certificate Expiration DateAugust 11, 2027
Laboratory DirectorJose Quimbayo
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC825 W Linebaugh Ave, Tampa, FL 33612
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2027509

Optumcare Florida LLC · Tampa, FL
Active · expires Jul 25, 2027
CLIA Number10D2027509
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorAdrienne Serneels
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC14451 University Cove Pl, Tampa, FL 33613
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2017521

Optumcare Florida LLC · Tampa, FL
Active · expires Dec 12, 2026
CLIA Number10D2017521
Laboratory TypePhysician Office
Certificate Effective DateDecember 13, 2024
Certificate Expiration DateDecember 12, 2026
Laboratory DirectorAngel Perez-Sori
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC3010 W Azeele St - Suite 100, Tampa, FL 33609
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0857098

Optumcare Florida LLC · Tampa, FL
Active · expires Aug 31, 2026
CLIA Number10D0857098
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorRajay Seudath
Laboratory Phone(407) 258-3186
Laboratory LocationOptumcare Florida LLC14701 N Florida Ave, Tampa, FL 33613
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Optumcare Florida, LLC's NPI number?

The NPI number for Optumcare Florida, LLC is 1245390475. It was assigned to this organization in the NPPES registry on December 11, 2006. The provider is doing business as Davita Medical Group, Pharmacy.

Where is Optumcare Florida, LLC located?

Optumcare Florida, LLC is located at 3665 W Waters Ave, Tampa, FL 33614. The listed phone number is (813) 935-6431.

What is Optumcare Florida, LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Optumcare Florida, LLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Optumcare Florida, LLC was last updated on August 20, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.