Provider Demographics
NPI:1992256002
Name:OPTUMRX
Entity type:Organization
Organization Name:OPTUMRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-943-3599
Mailing Address - Street 1:2300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6223
Mailing Address - Country:US
Mailing Address - Phone:949-475-3466
Mailing Address - Fax:949-474-4237
Practice Address - Street 1:2300 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6223
Practice Address - Country:US
Practice Address - Phone:949-475-3466
Practice Address - Fax:949-474-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64702282N00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No282N00000XHospitalsGeneral Acute Care Hospital