Active NPI
Optum Pharmacy 702, LLC
- Community/Retail Pharmacy
- Jeffersonville, IN
National Provider Identifier
1083045140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- OPTUM PHARMACY 702, LLC
- Practice address
- 1050 Patrol Rd
Jeffersonville, IN 47130-7750 - Phone
- (855) 427-4682
- Fax
- (877) 342-4596
- NPI assigned
- Nov 27, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Denise McCabe
- Title
- Secretary
- Phone
- (820) 245-4968
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1050 Patrol Rd
Jeffersonville, IN 47130-7750
Mailing address
1 Optum Cir Ste 100
Eden Prairie, MN 55344-2956
Phone (800) 328-5979
Other names 1
- BriovaRx
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140603000335 | IN | DME Supplier - Pharmacy | 7012130412 | Practice locations: Jeffersonville, IN |
National Provider Directory
National Provider Directory- Tax ID family
- Optum Pharmacy 702 LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mail Order Pharmacy
- Jeffersonville, IN
- NPI 1326846585
Locations
1050 Patrol Rd
Jeffersonville, IN 47130
Phone (855) 242-2241
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385510400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1783900800000",
"number": "1083045140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 OPTUM CIR STE 100",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553442956",
"telephone_number": "800-328-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 PATROL RD",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471307750",
"telephone_number": "855-427-4682",
"fax_number": "877-342-4596"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPTUM PHARMACY 702, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-11-27",
"last_updated": "2026-07-13",
"certification_date": "2026-07-13",
"status": "A",
"authorized_official_last_name": "MCCABE",
"authorized_official_first_name": "DENISE",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "820-245-4968"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "BriovaRx",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "BriovaRx",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.