OrganizationActive
Optum Pharmacy 704, Inc.
NPI 1154893600 · Mail Order Pharmacy · San Antonio, TX
Provider details
- NPI number
- 1154893600
- Entity type
- Organization
- Primary specialty
- Mail Order PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kevin Burr, Secretary(712) 310-4701
Specialties & taxonomies
Suppliers
- Pharmacy333600000X
Suppliers
Practice location
5627 University Hts Ste 108
San Antonio, TX 78249-3583
Phone: (800) 562-6223
Fax: (800) 491-7997
Approximate (ZIP-level) locationGet directions
Mailing address
1 Optum Cir Ste 100
Eden Prairie, MN 55344-2503
Registry dates
- Enumerated
- 2018-12-21
- Last updated
- 2024-12-04
- Certified
- 2024-12-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.