Provider Demographics
NPI:1598087470
Name:CAPOCASALE, EUGENE RANDAL
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:RANDAL
Last Name:CAPOCASALE
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 1:401 E POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5045
Mailing Address - Country:US
Mailing Address - Phone:785-776-4070
Mailing Address - Fax:785-776-1634
Practice Address - Street 1:401 E POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5045
Practice Address - Country:US
Practice Address - Phone:785-776-4070
Practice Address - Fax:785-776-1634
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist