Provider Demographics
NPI:1619273687
Name:CAPITOL PHARMACY INC
Entity Type:Organization
Organization Name:CAPITOL PHARMACY INC
Other - Org Name:RANCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-617-4321
Mailing Address - Street 1:2923 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2910
Mailing Address - Country:US
Mailing Address - Phone:916-617-4321
Mailing Address - Fax:916-617-2727
Practice Address - Street 1:4220 FLORIN RD # 111
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2508
Practice Address - Country:US
Practice Address - Phone:916-231-0277
Practice Address - Fax:916-231-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50589333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619273687Medicaid
2129859OtherPK
CA1619273687Medicaid