=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205040060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE APOTHECARY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1384 CAPE SAINT CLAIRE RD
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21409-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-757-3522
-----------------------------------------------------
Fax | 410-626-7226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1384 CAPE SAINT CLAIRE RD
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21409-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-757-3522
-----------------------------------------------------
Fax | 410-626-7226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS J WILSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 410-757-3522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 08249
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------