Organization
OPTUM PHARMACY 702, LLC
Active
Other names
BriovaRx
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN EUGENE BURR (SECRETARY)
(712) 310-4701
Entity
Organization
Contact information
Practice address
1050 PATROL RD, JEFFERSONVILLE, IN 47130-7750
(855) 427-4682
(877) 342-4596
Mailing address
1 OPTUM CIR STE 100, EDEN PRAIRIE, MN 55344-2503
(800) 328-5979
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
11/27/2013
Last updated
02/04/2025
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