Provider Demographics
NPI:1205040060
Name:CAPE APOTHECARY
Entity Type:Organization
Organization Name:CAPE APOTHECARY
Other - Org Name:T/A CAPE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:410-757-3522
Mailing Address - Street 1:1384 CAPE SAINT CLAIRE RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5325
Mailing Address - Country:US
Mailing Address - Phone:410-757-3522
Mailing Address - Fax:410-626-7226
Practice Address - Street 1:1384 CAPE SAINT CLAIRE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5325
Practice Address - Country:US
Practice Address - Phone:410-757-3522
Practice Address - Fax:410-626-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty