OPTUM PHARMACY 805, INC. (NPI# 1255523155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255523155 |
| Entity Type | Organization |
| Organization Name | OPTUM PHARMACY 805, INC. |
| Practice Address |
1101 N Central Ave Ste 102 Phoenix AZ 85004-1818 |
| Mailing Address |
1101 N Central Ave Ste 102 Phoenix AZ 85004-1829 |
| Practice Telephone | 6022571133 |
| Practice Fax Number | 6022571134 |
| Mailing Telephone | 8777196349 |
| Mailing Fax Number | 8777196362 |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2020-05-28 |
| Authorized Official Name | DAVID OBERG (ASSISTANT SECRETARY) |
| Authorized Official Telephone | 9529361300 |
| Is Organization Subpart | Y |
| Parent Organization Name | APOTHECARY HOLDINGS INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Y005085 | AZ | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Y005085 | AZ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 0354934 | 01 | |
| AZ | 283080 | 05 |
| Street Address |
1101 N CENTRAL AVE STE 102 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85004-1818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104363183 | Joy Lynne Golden | Social Worker | 1101 N Central Ave, Suite 100, Phoenix, AZ 85004-1808 | 2017-01-27 |
| 1467827139 | Jesse Samuel Kern | Social Worker | 1101 N Central Ave, Ste 200, Phoenix, AZ 85004-1808 | 2015-12-07 |
| 1629497474 | Maricopa County Special Health Care District | General Acute Care Hospital | 1101 N Central Ave, 2nd Floor, Phoenix, AZ 85004-1818 | 2014-04-09 |
| 1437448859 | Faith M Carroll | Nurse Practitioner | 1101 N Central Ave, Ste 200, Phoenix, AZ 85004-1808 | 2011-04-06 |
| 1306160577 | Avella of Phoenix IIi, Inc | Pharmacy | 1101 N Central Ave, Suite 102, Phoenix, AZ 85004-1818 | 2010-03-17 |
| 1255665147 | Julie Mcallister | Counselor | 1101 N Central Ave, Suite 200, Phoenix, AZ 85004-1818 | 2009-09-24 |
| 1922147511 | Carolyn M Fuller | Naturopath | 1101 N Central Ave, #200, Phoenix, AZ 85004-1818 | 2007-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396360749 | Ulivvo Inc. | Nurse Practitioner | 141 E Palm Lane, Suite 206, Phoenix, AZ 85004 | 2020-06-11 |
| 1508325929 | Ican America | Clinic/Center | Cityscape Tower 1 E Washington St., Suite 440, Phoenix, AZ 85004 | 2019-03-15 |
| 1770064107 | Edward Jude Stein | Pharmacist | Two Renaissance Square, 40 N Central Ave, Suite 780, Ihs Clinical Support Center, Phoenix, AZ 85004 | 2018-08-23 |
| 1740775303 | Alexander L. Shaw | Dentist | 201 N Central Ave. #1490, Phoenix, AZ 85004 | 2018-06-26 |
| 1497267868 | Michael Dimoff | Registered Nurse | 1850 N. Central Ave, Ste 1600, Phoenix, AZ 85004 | 2017-10-25 |
| 1093231433 | Ezequiel Bautista | Music Therapist | 2702 N 3rd Street, Suite 1000, Phoenix, AZ 85004 | 2017-08-17 |
| 1841742442 | Stacy Maahs | Nurse Practitioner | 500 N 3rd St Ste 155, Phoenix, AZ 85004 | 2016-10-29 |
| 1538537246 | Jessica Lindsay Karlson | Pharmacist | 2302 N Central Ave Ste 7, Phoenix, AZ 85004 | 2015-09-11 |
| 1689059883 | Yvette's Hope Foundation | Home Health | 40 N. Central Ave. Ste. 1400, Phoenix, AZ 85004 | 2015-07-29 |
| 1881082790 | Patricia Russell | Specialist/Technologist | 60 E. Vernon Ave, Arcadia Therapy Services, Phoenix, AZ 85004 | 2014-12-30 |
| Find all providers in zip 85004 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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] |
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| 1164981643 | North Valley Pharmacy LLC | Pharmacy | 34975 N North Valley Pkwy Bldg 5, Phoenix, AZ 85086-4028 | 2019-03-14 |
| 1821569633 | Healthrx Pharmacy, LLC. | Pharmacy | 727 E Bethany Home Rd Ste B110, Phoenix, AZ 85014-2151 | 2018-12-06 |
| 1821572405 | Tramanto Community Pharmacy | Pharmacy | 2633 W Carefree Hwy Ste 115, Phoenix, AZ 85085-8864 | 2018-09-19 |
| 1699254839 | Corner Pharmacy Incorporated | Pharmacy | 112 N 5th Ave Ste 101, Phoenix, AZ 85003 | 2018-08-08 |
| 1053818096 | Nixona Rx, LLC | Pharmacy | 1614 E Mcdowell Rd, Phoenix, AZ 85006-3032 | 2018-04-06 |
| 1841795887 | Nimble Pharmacy Inc | Pharmacy | 3702 E Roeser Rd Ste 5, Phoenix, AZ 85040-9047 | 2018-03-29 |
| 1881107696 | Julie Faye House | Pharmacy | 2655 E Brown St, Phoenix, AZ 85028-4314 | 2017-11-15 |
| 1295248268 | German Dobson Cvs, L.L.C. | Pharmacy | 5450 W Happy Valley Rd, Phoenix, AZ 85083-2949 | 2017-11-13 |
| 1073069860 | Bgh Pharmacy | Pharmacy | 3544 W Glendale Ave Ste E, Phoenix, AZ 85051-8359 | 2016-08-31 |
| Find all providers in PHOENIX | ||||
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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.