Healthcare Provider Details

I. General information

NPI: 1023005741
Provider Name (Legal Business Name): MARY VIRGINIA CAPUTI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21281 GRAYTON TER DOUGLAS T. JACOBSON STATE VETERANS NURSING HOME
PORT CHARLOTTE FL
33954-3109
US

IV. Provider business mailing address

2237 PINELAND DR
ENGLEWOOD FL
34223-6332
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-2710
  • Fax:
Mailing address:
  • Phone: 941-235-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS 21984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: