Provider Demographics
NPI:1740568666
Name:CAPITAL PHARMACY, LLC
Entity Type:Organization
Organization Name:CAPITAL PHARMACY, LLC
Other - Org Name:CAPITAL PHARMACY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7100
Mailing Address - Street 1:1340 AIRPORT COMMERCE DR
Mailing Address - Street 2:BLDG. 3 STE 350
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741
Mailing Address - Country:US
Mailing Address - Phone:512-628-8877
Mailing Address - Fax:512-628-8878
Practice Address - Street 1:1340 AIRPORT COMMERCE DR
Practice Address - Street 2:BLDG. 3 STE 350
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:512-628-8877
Practice Address - Fax:512-628-8878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY CORPORATION OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-26
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275553336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5903756OtherNCPDP
TX22115Medicaid
2131399OtherPK