Healthcare Provider Details

I. General information

NPI: 1477636421
Provider Name (Legal Business Name): CAPITANO PHARMACEUTICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 S MAIN ST STE 1
OLD FORGE PA
18518-1497
US

IV. Provider business mailing address

821 S MAIN ST STE 1
OLD FORGE PA
18518-1497
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-5450
  • Fax: 570-457-1190
Mailing address:
  • Phone: 570-457-5450
  • Fax: 570-457-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414814L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3967429
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER
# 2
Identifier001431934
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: PETER CAPITANO
Title or Position: OWNER PHCST
Credential:
Phone: 570-237-6376