Provider Demographics
NPI:1376904755
Name:CAPPS, CAROL DIANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DIANNE
Last Name:CAPPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SANDHILLS LN
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-4962
Mailing Address - Country:US
Mailing Address - Phone:806-324-5542
Mailing Address - Fax:866-589-7656
Practice Address - Street 1:216 S POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1407
Practice Address - Country:US
Practice Address - Phone:806-324-5542
Practice Address - Fax:866-589-7656
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist