Provider Demographics
NPI:1477622025
Name:CAPE CORAL EXPRESS PHARMACY INC
Entity Type:Organization
Organization Name:CAPE CORAL EXPRESS PHARMACY INC
Other - Org Name:CAPE CORAL EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-287-5893
Mailing Address - Street 1:505 DEL PRADO BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2269
Mailing Address - Country:US
Mailing Address - Phone:239-574-8846
Mailing Address - Fax:239-574-7080
Practice Address - Street 1:505 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2269
Practice Address - Country:US
Practice Address - Phone:239-574-8846
Practice Address - Fax:239-574-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH223503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1024114OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL5952920001Medicare NSC