MEDICARE: EUGENE ROBERT CAPOGROSSO III R.PH.

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	037019	NY

General Provider Information

NPI Number	:	1669064861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE ROBERT CAPOGROSSO III R.PH.

Provider Business Mailing Address
First Line	:	1106 E 73RD ST APT 25
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5451
Country	:	US
Telephone Number	:	718-594-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 COMMERCE AVE FRNT 3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3612
Country	:	US
Telephone Number	:	347-612-8456
Fax Number	:	347-328-5616

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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