Provider Demographics
NPI:1972557759
Name:CAPEL, KIM DALLAS I (RPH,MS)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:DALLAS
Last Name:CAPEL
Suffix:I
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 APPLE LANE
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906
Mailing Address - Country:US
Mailing Address - Phone:618-833-4017
Mailing Address - Fax:
Practice Address - Street 1:214 APPLE LN
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1116
Practice Address - Country:US
Practice Address - Phone:618-833-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40192183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist