Healthcare Provider Details

I. General information

NPI: 1184705154
Provider Name (Legal Business Name): CAPITOL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S WASHINGTON SQ
LANSING MI
48933-1703
US

IV. Provider business mailing address

109 S WASHINGTON SQ
LANSING MI
48933-1703
US

V. Phone/Fax

Practice location:
  • Phone: 517-702-1111
  • Fax: 517-702-1102
Mailing address:
  • Phone: 517-702-1111
  • Fax: 517-702-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5301007177
License Number StateMI

VIII. Authorized Official

Name: MS. POLLYANNA COVE
Title or Position: PHARMACIST
Credential: RPH
Phone: 517-702-1111