OPTUM PHARMACY 704, INC. (NPI# 1154893600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154893600 |
| Entity Type | Organization |
| Organization Name | OPTUM PHARMACY 704, INC. |
| Practice Address |
5627 University Hts Ste 108 San Antonio TX 78249-3583 |
| Mailing Address |
Po Box 848119 Los Angeles CA 90084-8119 |
| Practice Telephone | 8005626223 |
| Practice Fax Number | 8004917997 |
| Mailing Telephone | 8005626223 |
| Mailing Fax Number | 8004917997 |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2020-03-06 |
| Authorized Official Name | DAVID OBERG (VICE PRESIDENT, COMPLIANCE) |
| Authorized Official Telephone | 9499885893 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| BriovaRx of Texas | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457408536 | Optum Pharmacy 704, Inc. | Pharmacy | 5627 University Hts Ste 108, San Antonio, TX 78249-3583 | 2007-01-04 |
| Street Address |
5627 UNIVERSITY HTS STE 108 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78249-3583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457408536 | Optum Pharmacy 704, Inc. | Pharmacy | 5627 University Hts Ste 108, San Antonio, TX 78249-3583 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222663 | Zachary Mitchell Kimo Mitsui | Specialist/Technologist | 7311 Bluestone Rd, San Antonio, TX 78249 | 2020-10-15 |
| 1538770839 | Go Operations 3 LLC | Skilled Nursing Facility | 4366 Lockhill Selma, Shavano, TX 78249 | 2020-08-11 |
| 1417566548 | Heenaben Jayantilal Rathod | Registered Nurse | 5803 Utsa Blvd, Apt #2101, San Antonio, TX 78249 | 2020-07-24 |
| 1306455530 | Z-pediatrics Pllc | Pediatrics | 5886 Dezavala Rd Suite 101 #510, San Antonio, TX 78249 | 2020-07-23 |
| 1568080497 | San Antonio Wisdom Teeth, Pllc | Dentist | 13535 Hausman Pass #102-a, San Antonio, TX 78249 | 2020-07-07 |
| 1265071203 | Caralyne Sandquist | Physician Assistant | 5510 Presidio Parkway, Building #2 Suite 2401, San Antonio, TX 78249 | 2019-12-21 |
| 1104472935 | Adam J Gordon | Social Worker | 6363 Dezavala Rd, San Antonio, TX 78249 | 2019-08-16 |
| 1336700582 | Michael Leland Post | Specialist/Technologist | 5150 Dezavala, San Antonio, TX 78249 | 2019-06-27 |
| 1043788722 | Stephen John Reynolds | Counselor | 5907 Trent Rnch, San Antonio, TX 78249 | 2018-11-11 |
| 1396211504 | Christina Michelle Morales | Specialist/Technologist | 4533 N Loop 1604 E, Ste 1119, San Antonio, TX 78249 | 2018-10-16 |
| Find all providers in zip 78249 | ||||
| Taxonomy Code | 3336M0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Mail Order Pharmacy |
| A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174921803 | One Source Pharmacy and Medical Supplies LLC | Pharmacy | 15733 San Pedro Ave, San Antonio, TX 78232-3726 | 2014-12-11 |
| 1770121279 | Recept Pharmacy, Lp | Pharmacy | 9150 Huebner Rd Ste 125, San Antonio, TX 78240-1658 | 2019-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972230 | Covetrus Pharmacy Services, LLC | Pharmacy | 14800 Faa Blvd Ste 150, Fort Worth, TX 76155-2252 | 2020-11-02 |
| 1821612441 | Genesis Apothecary Inc | Pharmacy | 101 Southwestern Blvd Ste 100, Sugar Land, TX 77478-3548 | 2020-05-29 |
| 1801419692 | Jolanto Corporation | Pharmacy | 10101 Southwest Fwy Ste 315, Houston, TX 77074-1111 | 2020-05-27 |
| 1407494917 | Recept Pharmacy, Lp | Pharmacy | 10412 Vista Del Sol Dr Ste 1a, El Paso, TX 79925-7937 | 2019-12-16 |
| 1396381935 | Recept Pharmacy, Lp | Pharmacy | 800 8th Ave Ste 130, Fort Worth, TX 76104-2606 | 2019-11-19 |
| 1265074207 | Health America LLC | Pharmacy | 541 W Main St Ste 140, Lewisville, TX 75057-3666 | 2019-10-10 |
| 1144871245 | Scriptco | Pharmacy | 6916 Woodway Dr, Woodway, TX 76712-6148 | 2019-09-20 |
| 1801365366 | Debons Business Management Inc D/b/a Joe Pil | Pharmacy | 6909 W Fm 2147, Horseshoe Bay, TX 78657-6434 | 2018-11-14 |
| 1821584764 | Randal Riverside Corporation | Pharmacy | 3360 Matlock Rd, Arlington, TX 76015-2907 | 2018-07-03 |
| 1215421227 | Randal Riverside Corporation | Pharmacy | 3360 Matlock Rd # 100, Arlington, TX 76015-2907 | 2018-06-22 |
| Find all providers with the same taxonomy | ||||
| City | SAN ANTONIO |
| Zip Code | 78249 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.