Provider Demographics
NPI:1760889448
Name:OPTUMRX HOME DELIVERY OF ILLINOIS LLC
Entity Type:Organization
Organization Name:OPTUMRX HOME DELIVERY OF ILLINOIS LLC
Other - Org Name:OPTUMRX OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-201-3665
Mailing Address - Street 1:1600 MCCONNOR PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2441 WARRENVILLE RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3664
Practice Address - Country:US
Practice Address - Phone:630-328-5912
Practice Address - Fax:877-762-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0198643336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148935OtherPK