Healthcare Provider Details

I. General information

NPI: 1023337615
Provider Name (Legal Business Name): CHRISTOPHER CAPO B.S., PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 05/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 GRAND CENTRAL AVE
LAVALLETTE NJ
08735-2214
US

IV. Provider business mailing address

62 K ST
SEASIDE PARK NJ
08752-1417
US

V. Phone/Fax

Practice location:
  • Phone: 732-793-1910
  • Fax:
Mailing address:
  • Phone: 732-600-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02581700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: