Provider Demographics
NPI:1497885024
Name:CAPPETTA, THOMAS J
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:CAPPETTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39W020 CRANSTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6831
Mailing Address - Country:US
Mailing Address - Phone:630-762-0012
Mailing Address - Fax:847-559-3428
Practice Address - Street 1:39W020 CRANSTON RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6831
Practice Address - Country:US
Practice Address - Phone:630-762-0012
Practice Address - Fax:847-559-3428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist