Provider Demographics
NPI:1184736019
Name:PEOPLE'S PHARMACY INC.
Entity type:Organization
Organization Name:PEOPLE'S PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-802-1990
Mailing Address - Street 1:4977 US HWY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809
Mailing Address - Country:US
Mailing Address - Phone:863-858-4444
Mailing Address - Fax:863-858-4832
Practice Address - Street 1:4977 US HWY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809
Practice Address - Country:US
Practice Address - Phone:863-858-4444
Practice Address - Fax:863-858-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH187483336C0003X
FLPH261633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1007233OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL025599800Medicaid