MEDICARE: PETER N CAPOBIANCO RPH

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	50639	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570390	OTHER		NABP NUMBER

General Provider Information

NPI Number	:	1447853387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER N CAPOBIANCO RPH

Provider Business Mailing Address
First Line	:	1088 E DEEPAK RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4955
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31575 DATE PALM DR
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3138
Country	:	US
Telephone Number	:	760-324-4239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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