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
4757 US HIGHWAY 19 STE A, NEW PORT RICHEY, FL 34652-4945
(727) 849-9373
(727) 815-1203
Mailing address
4757 US HIGHWAY 19, SUITE A, NEW PORT RICHEY, FL 34652-4945
(727) 849-9373
(727) 815-1203
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
PH24634
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5700198
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/03/2010
Last updated
08/19/2019
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