1629409180 NPI number — VERSAILLES INDEPENDENT PHARMACY, INC.

Table of content: ANTHONY JAMES CAPRIO MD (NPI 1659459659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629409180 NPI number — VERSAILLES INDEPENDENT PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERSAILLES INDEPENDENT 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:
VERSAILLES INDEPENDENT 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:
1629409180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 PAYNES DEPOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40511-9149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-967-3794
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 FRANKFORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERSAILLES
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40383-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-879-0199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
CARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PIC
Authorized Official Telephone Number:
859-967-3794

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P07601 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2143326 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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