Organization
OPTUMCARE FLORIDA, LLC
Active
Other names
DaVita Medical Group, Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
3665 W WATERS AVE, TAMPA, FL 33614-2783
(813) 935-6431
(813) 915-0741
Mailing address
10051 5TH ST. N, ST. PETERSBURG, FL 33702-2289
(727) 828-2314
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH18512
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030842100
—
FL
01
—
2014551
PK
—
05
—
4399230005
—
FL
Enumeration date
12/11/2006
Last updated
08/20/2019
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