OPTUM PHARMACY 801, INC.

Provider Demographics

• NPI: 1780030163
• Name: OPTUM PHARMACY 801, INC.
• Entity Type: Organization
• Organization Name: OPTUM PHARMACY 801, INC.
• Authorized Official - Title/Position: SECRETARY
• Authorized Official - First Name: KEVIN
• Authorized Official - Middle Name: EUGENE
• Authorized Official - Last Name: BURR
• Authorized Official - Phone: 712-310-4701
• Mailing Address - Street 1: 11000 OPTUM CIR STE 100
• Mailing Address - City: EDEN PRAIRIE
• Mailing Address - State: MN
• Mailing Address - Zip Code: 55344-2503
• Mailing Address - Country: US
• Mailing Address - Phone: 800-328-5979
• Practice Address - Street 1: 24416 N 19TH AVE STE 100
• Practice Address - City: PHOENIX
• Practice Address - State: AZ
• Practice Address - Zip Code: 85085-1889
• Practice Address - Country: US
• Practice Address - Phone: 877-719-6349
• Practice Address - Fax: 877-719-6362
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2016-05-04
• Last Update Date: 2024-02-13

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy
No	251F00000X	Agencies	Home Infusion
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	333600000X	Suppliers	Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ID	1780030163	Medicaid
OH	218209	Medicaid
NE	10026395601	Medicaid
AZ	195019	Medicaid
MD	113465500	Medicaid
OR	1780030163	Medicaid
VT	1029015	Medicaid
MS	829277	Medicaid
NC	1780030163	Medicaid
CO	1780030163	Medicaid
UT	1780030163	Medicaid
WA	2078611	Medicaid
OK	200227450C	Medicaid
KS	200587210B	Medicaid
PA	1022434680002	Medicaid
NV	1780030163	Medicaid
MT	1780030163	Medicaid
SC	7A6872	Medicaid
AK	1664421	Medicaid