Provider Demographics
NPI:1720689987
Name:CAPSULE SAN DIEGO LLC
Entity type:Organization
Organization Name:CAPSULE SAN DIEGO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KINARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-685-9515
Mailing Address - Street 1:122 W 146TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3802
Mailing Address - Country:US
Mailing Address - Phone:888-685-9515
Mailing Address - Fax:646-934-6409
Practice Address - Street 1:1450 COLUMBIA ST STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3487
Practice Address - Country:US
Practice Address - Phone:760-452-3522
Practice Address - Fax:646-934-6409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSULE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-04
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy