MEDICARE: CAPAK INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	FL10967	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336146919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPAK INCORPORATED

Provider Business Mailing Address
First Line	:	1615 14TH AVE # 1635
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-562-3660
Fax Number	:	772-562-3650

Provider Business Practice Location Address
First Line	:	1615-1635 14TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-562-3660
Fax Number	:	772-562-3650

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DOUGLAS T MILLER
Credential	:	RPH
Telephone Number	:	772-778-8585

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/29/2009

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Directions to “CAPAK INCORPORATED ” Practice Location

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