Provider Demographics
NPI:1689047441
Name:CAPITAL CITY PHARMACY
Entity Type:Organization
Organization Name:CAPITAL CITY PHARMACY
Other - Org Name:CAPITAL CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:METU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-644-2272
Mailing Address - Street 1:339 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5906
Mailing Address - Country:US
Mailing Address - Phone:707-644-2272
Mailing Address - Fax:707-644-2338
Practice Address - Street 1:339 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5906
Practice Address - Country:US
Practice Address - Phone:707-644-2272
Practice Address - Fax:707-644-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
CA537423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689047441Medicaid
2155080OtherPK
2155080OtherPK