Provider Demographics
NPI:1235474032
Name:CAPE RX LLC
Entity type:Organization
Organization Name:CAPE RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:302-645-0090
Mailing Address - Street 1:17252 E VILLAGE MAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-645-0090
Mailing Address - Fax:302-645-0096
Practice Address - Street 1:38 EAGLE DR
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-1445
Practice Address - Country:US
Practice Address - Phone:302-260-9198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7024350001Medicare NSC