Healthcare Provider Details

I. General information

NPI: 1396726246
Provider Name (Legal Business Name): CAPE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/28/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MAIN ST
SCOTT CITY MO
63780-1329
US

IV. Provider business mailing address

2220 MAIN ST
SCOTT CITY MO
63780-1329
US

V. Phone/Fax

Practice location:
  • Phone: 573-264-2450
  • Fax: 573-264-4741
Mailing address:
  • Phone: 573-264-2450
  • Fax: 573-264-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number005567
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005567
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier620203505
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier2606866
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerNABP
# 3
Identifier600203509
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MR. JOHN PETER SCHREIBER
Title or Position: OWNER
Credential:
Phone: 314-497-9311