Provider Demographics
NPI:1831785021
Name:CAPPELLANO, JOHN ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:CAPPELLANO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TEATICKET HWY
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5615
Mailing Address - Country:US
Mailing Address - Phone:508-540-4711
Mailing Address - Fax:844-411-6770
Practice Address - Street 1:20 TEATICKET HWY
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5615
Practice Address - Country:US
Practice Address - Phone:508-540-4711
Practice Address - Fax:844-411-6770
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist