Provider Demographics
NPI:1255873766
Name:OPTUMRX HOME DELIVERY OF OHIO LLC
Entity type:Organization
Organization Name:OPTUMRX HOME DELIVERY OF OHIO LLC
Other - Org Name:
Other - Org Type:
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 1:1 NATIONWIDE PLZ
Mailing Address - Street 2:ATTN: JAMES RICKET
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2226
Mailing Address - Country:US
Mailing Address - Phone:614-222-0045
Mailing Address - Fax:614-222-0800
Practice Address - Street 1:1 NATIONWIDE PLZ
Practice Address - Street 2:ATTN: JAMES RICKETT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2226
Practice Address - Country:US
Practice Address - Phone:614-222-0045
Practice Address - Fax:614-222-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166439OtherPK