OPTUM PHARMACY 703, LLC NPI 1720364532

Pharmacy (Community/Retail Pharmacy) in Las Vegas, NV

Organization Pharmacy Community/Retail Pharmacy

About OPTUM PHARMACY 703, LLC

Optum Pharmacy 703, Llc is a provider established in Las Vegas, Nevada specializing in pharmacy. The NPI number of Optum Pharmacy 703, Llc is 1720364532 and was assigned on October 2011. The practitioner's primary taxonomy code is 3336C0003X. The provider is registered as an organization and their NPI record was last updated October 2019. The authorized official of this NPI record is David Oberg (Vice President, Compliance)

NPI

1720364532

Provider NameOPTUM PHARMACY 703, LLC
Provider Location Address8350 BRIOVA DR LAS VEGAS, NV 89113
Provider Mailing AddressOPTUM PHARMACY 703, LLC P.O. BOX 851378 MINNEAPOLIS, MN 55485
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date10-25-2011
Last Update Date10-09-2019

Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
Taxonomy DescriptionA 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.

Business Address

OPTUM PHARMACY 703, LLC
8350 BRIOVA DR
LAS VEGAS, NV
ZIP 89113
Phone: (702) 954-8659
Fax: (702) 634-5502

Get Directions

Mailing Address

OPTUM PHARMACY 703, LLC
OPTUM PHARMACY 703, LLC
P.O. BOX 851378
MINNEAPOLIS, MN
ZIP 55485
Phone: (855) 577-6521
Fax: (812) 285-8541

Authorized Official

Authorized Official Name DAVID OBERG
Authorized Official TitleVICE PRESIDENT, COMPLIANCE
Authorized Official Phone(949) 988-5893

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1333600000XSuppliersPharmacyNo

Taxonomy Description: a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

23336S0011XSuppliersPharmacySpecialty PharmacyPH02731NVNo

Taxonomy Description: a pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
1720364532MEDICAID (05)NV
2132173OTHER (01)
PH02731OTHER (01)NV

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1437526316OPTUM PHARMACY 703, LLC
Organization
Pharmacy (Mail Order Pharmacy)8350 BRIOVA DR
LAS VEGAS, NV 89113
(702) 954-8660
1558898080 ROSEMARIEAN GRACE A. BARREDO RPH, RN
Individual
Pharmacist8350 BRIOVA DR
LAS VEGAS, NV 89113
(855) 855-8754
1891078531 KENNETH M TO R. PH.
Individual
Pharmacist8350 BRIOVA DR
LAS VEGAS, NV 89113
(855) 427-4682

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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