Provider Demographics
NPI:1669865762
Name:CAPSTONE PHARMACY, INC
Entity Type:Organization
Organization Name:CAPSTONE PHARMACY, INC
Other - Org Name:CAPSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-321-3236
Mailing Address - Street 1:210 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2017
Mailing Address - Country:US
Mailing Address - Phone:319-385-0733
Mailing Address - Fax:319-385-0735
Practice Address - Street 1:210 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2017
Practice Address - Country:US
Practice Address - Phone:319-385-0733
Practice Address - Fax:319-385-0735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEEL BLUE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15113336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0216975Medicaid