Healthcare Provider Details

I. General information

NPI: 1740568666
Provider Name (Legal Business Name): CAPITAL PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 AIRPORT COMMERCE DR BLDG. 3 STE 350
AUSTIN TX
78741
US

IV. Provider business mailing address

1340 AIRPORT COMMERCE DR BLDG. 3 STE 350
AUSTIN TX
78741
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-8877
  • Fax: 512-628-8878
Mailing address:
  • Phone: 512-628-8877
  • Fax: 512-628-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number27555
License Number StateTX

VIII. Authorized Official

Name: THOMAS A. CANERIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-627-7100