Provider Demographics
NPI:1962048678
Name:CAPSULE PHILADELPHIA LLC
Entity type:Organization
Organization Name:CAPSULE PHILADELPHIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
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 1:117 S 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4606
Practice Address - Country:US
Practice Address - Phone:215-867-8777
Practice Address - Fax:215-330-4933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSULE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037763620001Medicaid