Healthcare Provider Details

I. General information

NPI: 1508364282
Provider Name (Legal Business Name): CAPSULE LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8065 W 3RD STREET
LOS ANGELES CA
90048-4316
US

IV. Provider business mailing address

122 W 146TH ST
NEW YORK NY
10039-3802
US

V. Phone/Fax

Practice location:
  • Phone: 323-792-1444
  • Fax: 323-919-8862
Mailing address:
  • Phone: 888-685-9515
  • Fax: 646-934-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55822
License Number StateCA

VIII. Authorized Official

Name: MR. ERIC KINARIWALA
Title or Position: SOLE MEMBER
Credential:
Phone: 888-685-9515