Cape Pharmacy LLC

Organization Active NPI Community/Retail Pharmacy · Cape Girardeau, MO

NPI 1609120484 · NPPES record last updated May 20, 2026

Key facts

NPI
1609120484
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
2012041949 (MO)
Legal business name
CAPE PHARMACY LLC
Practice address
465 S Mount Auburn Rd Ste 101
Cape Girardeau, MO 63703-4931
Phone
(573) 651-5250
Fax
(573) 651-5230
NPI assigned
Nov 1, 2012
Organization subpart
No

Authorized official

Name
Casey Duncan
Title
Owner/Operations Manager
Phone
(573) 576-6562

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20140926001361 MO DME Supplier - Pharmacy 3779703665 Practice locations: Cape Girardeau, MO
O20141022000248 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3779703665 Practice locations: Cape Girardeau, MO

National Provider Directory

Tax ID family
Cape Pharmacy LLC (4 organizations share this tax ID)

Locations

465 S Mount Auburn Rd
Ste 101
Cpe Girardeau, MO 63703
Phone (573) 651-5250

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 2012041949 MO Yes

Addresses

Primary practice location

465 S Mount Auburn Rd Ste 101
Cape Girardeau, MO 63703-4931

Mailing address

465 S Mount Auburn Rd Ste 101
Cape Girardeau, MO 63703-4931
Phone (573) 651-5250

Other identifiers

IdentifierTypeStateIssuer
600002981MedicaidMO
2138274OtherPK

Other names

  • MediCenter Pharmacy Doing business as

Other providers in Cape Girardeau, MO

All providers in Cape Girardeau, MO · Community/Retail Pharmacy in Missouri

Sources for this page

Verify at the official NPI Registry.