Provider Demographics
NPI:1194723411
Name:CAPE PHARMACY LLC
Entity type:Organization
Organization Name:CAPE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRIFILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:302-645-0090
Mailing Address - Street 1:17252 N VILLAGE MAIN BLVD
Mailing Address - Street 2:#3
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6292
Mailing Address - Country:US
Mailing Address - Phone:302-645-0090
Mailing Address - Fax:302-645-0096
Practice Address - Street 1:17252 N VILLAGE MAIN BLVD
Practice Address - Street 2:#3
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6292
Practice Address - Country:US
Practice Address - Phone:302-645-0090
Practice Address - Fax:302-645-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10001506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023179Medicaid
DE5382900001Medicare NSC