Provider Demographics
NPI:1508364282
Name:CAPSULE LOS ANGELES LLC
Entity Type:Organization
Organization Name:CAPSULE LOS ANGELES LLC
Other - Org Name:CAPSULE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KINARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-685-9515
Mailing Address - Street 1:122 W 146TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3802
Mailing Address - Country:US
Mailing Address - Phone:888-685-9515
Mailing Address - Fax:646-934-6409
Practice Address - Street 1:8065 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4316
Practice Address - Country:US
Practice Address - Phone:323-792-1444
Practice Address - Fax:323-919-8862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSULE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-26
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336C0003X, 3336M0003X, 3336L0003X, 3336M0002X, 3336M0003X, 3336S0011X
CA558223336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508364282Medicaid
CA1962718387Medicaid
2176521OtherPK