Organization
OPTUMCARE FLORIDA, LLC
Active
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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