MEDICARE: CAPPUCCIO ENTERPRISE

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1881791044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPPUCCIO ENTERPRISE

Provider Business Mailing Address
First Line	:	2140 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1109
Country	:	US
Telephone Number	:	954-563-5331
Fax Number	:	954-563-5331

Provider Business Practice Location Address
First Line	:	2140 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1109
Country	:	US
Telephone Number	:	954-563-5331
Fax Number	:	954-563-5331

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. WILLIAM J CAPPUCCIO
Credential	:
Telephone Number	:	954-563-5331

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “CAPPUCCIO ENTERPRISE ” Practice Location

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