Provider Demographics
NPI:1376246942
Name:OPTUMRX PHARMACY OF NEVADA, INC.
Entity Type:Organization
Organization Name:OPTUMRX PHARMACY OF NEVADA, INC.
Other - Org Name:CULINARY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-310-4701
Mailing Address - Street 1:6350 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:844-231-9072
Mailing Address - Fax:844-265-0611
Practice Address - Street 1:6350 SOUTH DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:725-233-2100
Practice Address - Fax:725-223-2110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUMRX HEALTH SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy