Provider Demographics
NPI:1477721173
Name:CAPASSO, CARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:CAPASSO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2725
Mailing Address - Country:US
Mailing Address - Phone:610-356-6772
Mailing Address - Fax:610-356-9465
Practice Address - Street 1:2070 SPROUL RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2725
Practice Address - Country:US
Practice Address - Phone:610-356-6772
Practice Address - Fax:610-356-9465
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01407900183500000X
DEA1-0003345183500000X
PARP027580L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist