=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376136382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE MARIE CAPUTA BS, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2021
-----------------------------------------------------
Last Update Date | 10/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6129 W US HIGHWAY 60
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65619-9441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-708-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1676 TRACE HOLLOW RD
-----------------------------------------------------
City | LAMPE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65681-6367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-294-0625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835G0303X
-----------------------------------------------------
Taxonomy Name | Geriatric Pharmacist
-----------------------------------------------------
License Number | 042206
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 042206
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------