Provider Demographics
NPI:1477636421
Name:CAPITANO PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:CAPITANO PHARMACEUTICAL SERVICES INC
Other - Org Name:CAPITANO'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-237-6376
Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1497
Mailing Address - Country:US
Mailing Address - Phone:570-457-5450
Mailing Address - Fax:570-457-1190
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1497
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:2006-10-23
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
PAPP414814L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3967429OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA001431934Medicaid
0870230001Medicare NSC