Provider Demographics
NPI:1336146919
Name:CAPAK INCORPORATED
Entity Type:Organization
Organization Name:CAPAK INCORPORATED
Other - Org Name:OSCEOLA HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:772-778-8585
Mailing Address - Street 1:1615 14TH AVE # 1635
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0435
Mailing Address - Country:US
Mailing Address - Phone:772-562-3660
Mailing Address - Fax:772-562-3650
Practice Address - Street 1:1615-1635 14TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0435
Practice Address - Country:US
Practice Address - Phone:772-562-3660
Practice Address - Fax:772-562-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL10967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027088198Medicaid
FL677213700Medicaid
FL027088100Medicaid
FL027088196Medicaid
FL101464100Medicaid
FL677213700Medicaid