Provider Demographics
NPI:1457499444
Name:CAPITOL PHARMACY INC
Entity Type:Organization
Organization Name:CAPITOL PHARMACY INC
Other - Org Name:MORTONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:OREKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-543-1616
Mailing Address - Street 1:724 E CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1344
Mailing Address - Country:US
Mailing Address - Phone:202-543-1616
Mailing Address - Fax:202-543-5297
Practice Address - Street 1:724 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1344
Practice Address - Country:US
Practice Address - Phone:202-543-1616
Practice Address - Fax:202-543-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DCRX88000153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024722200Medicaid
0900743OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0900743OtherNCPDP PROVIDER IDENTIFICATION NUMBER