MEDICARE: CAPE PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	005567	MO
2	3336C0003X	Community/Retail Pharmacy	005567	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2606866	OTHER	MO	NABP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396726246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2220 MAIN ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1329
Country	:	US
Telephone Number	:	573-264-2450
Fax Number	:	573-264-4741

Provider Business Practice Location Address
First Line	:	2220 MAIN ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1329
Country	:	US
Telephone Number	:	573-264-2450
Fax Number	:	573-264-4741

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN PETER SCHREIBER
Credential	:
Telephone Number	:	314-497-9311

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	09/28/2022

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Directions to “CAPE PHARMACY, LLC ” Practice Location

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