Provider Demographics
NPI:1578184909
Name:CAPSULE PORTLAND LLC
Entity Type:Organization
Organization Name:CAPSULE PORTLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
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 1:416 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2907
Practice Address - Country:US
Practice Address - Phone:503-483-5353
Practice Address - Fax:503-343-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSULE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy