Provider Demographics
NPI:1043747785
Name:CAPE COD PHARMACY & HEALTH
Entity Type:Organization
Organization Name:CAPE COD PHARMACY & HEALTH
Other - Org Name:WHOLE HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD,RPH
Authorized Official - Phone:508-778-5928
Mailing Address - Street 1:596 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3465
Mailing Address - Country:US
Mailing Address - Phone:508-778-5928
Mailing Address - Fax:508-775-5929
Practice Address - Street 1:596 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3465
Practice Address - Country:US
Practice Address - Phone:508-778-5928
Practice Address - Fax:508-775-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA899333336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1316341845Medicaid
MA110100958AMedicaid
AK1655513Medicaid
PA103128021 0001Medicaid
MA110100958AMedicaid