MEDICARE: RUTH AVEGAIL RAGADIO CAPAPAS

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	183500000X	Pharmacist	051299100	IL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	T-14353	MS

General Provider Information

NPI Number	:	1578101135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH AVEGAIL RAGADIO CAPAPAS

Provider Business Mailing Address
First Line	:	602 N DAVIS AVE
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2356
Country	:	US
Telephone Number	:	662-843-0835
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 N DAVIS AVE
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2356
Country	:	US
Telephone Number	:	662-843-0835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	11/27/2023

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