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General NPI Number Information
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NPI Number | 1821802596
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Entity Type | Organization
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Legal Business Name | CAPSULE IDAHO LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 9050 W OVERLAND RD STE 245
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City | BOISE
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State | ID
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Zip | 83709-2722
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Country | US
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Telephone | 888-670-6317
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Fax | 646-934-6409
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Provider Business Mailing Address
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Address Line | 122 W 146TH ST
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City | NEW YORK
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State | NY
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Zip | 10039-3802
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Country | US
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Telephone | 888-685-9515
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Fax | 646-934-6409
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Authorized Official
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Title or Position | SOLE MEMBER/CEO
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Name | ERIC KINARIWALA
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Credential |
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Telephone | 888-685-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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