Provider Demographics
NPI:1073210100
Name:CAPITAL APOTHECARY II, LLC
Entity Type:Organization
Organization Name:CAPITAL APOTHECARY II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, DNP, RN
Authorized Official - Phone:713-498-2112
Mailing Address - Street 1:1319 RICHMOND AVE UNIT 667603
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-0073
Mailing Address - Country:US
Mailing Address - Phone:713-498-2112
Mailing Address - Fax:
Practice Address - Street 1:4306 YOAKUM BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5851
Practice Address - Country:US
Practice Address - Phone:713-498-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1804503457OtherFILING NUMBER