1457499444 NPI number — CAPITOL PHARMACY INC

Table of content: (NPI 1457499444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457499444 NPI number — CAPITOL PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MORTONS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457499444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 E CAPITOL ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20003-1344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-543-1616
Provider Business Mailing Address Fax Number:
202-543-5297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 E CAPITOL ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20003-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-543-1616
Provider Business Practice Location Address Fax Number:
202-543-5297
Provider Enumeration Date:
02/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OREKOYA
Authorized Official First Name:
SIMEON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
202-543-1616

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: RX8800015 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024722200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0900743 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".