Provider Demographics
NPI:1235245903
Name:CAPITANO'S PHARMACY
Entity Type:Organization
Organization Name:CAPITANO'S PHARMACY
Other - Org Name:CAPITANOS PHARMACEUTIAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CAPITANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-457-5450
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1600
Mailing Address - Country:US
Mailing Address - Phone:570-457-5450
Mailing Address - Fax:570-457-1190
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1600
Practice Address - Country:US
Practice Address - Phone:570-457-5450
Practice Address - Fax:570-457-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414814L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001431934-0001-24Medicaid
PA001431934-0001-24Medicaid