Provider Demographics
NPI:1033175625
Name:CAPITOL PHARMACY LLC
Entity Type:Organization
Organization Name:CAPITOL PHARMACY LLC
Other - Org Name:CAPITOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-895-3784
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0993
Mailing Address - Country:US
Mailing Address - Phone:517-702-1111
Mailing Address - Fax:248-449-0960
Practice Address - Street 1:109 S WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1703
Practice Address - Country:US
Practice Address - Phone:517-702-1111
Practice Address - Fax:248-449-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010071771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty