Red Cap Pharmacy 001 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011054 Issued in MI

Legal business name

RED CAP PHARMACY 001 LLC

Practice address

214 N West Ave Ste a
Jackson, MI 49201-1903

Phone

(517) 879-4877

Fax

(517) 879-1873

NPI assigned

Nov 29, 2016

Last updated

Jan 9, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohamad Issa Aboukhodr

Title

Owner

Phone

(517) 879-4877

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Red Cap Pharmacy 001 Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1619410321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 N. WEST AVE STE A",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-879-4877",
            "fax_number": "517-879-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 N WEST AVE STE A",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011903",
            "telephone_number": "517-879-4877",
            "fax_number": "517-879-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CAP PHARMACY 001 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-29",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "ABOUKHODR",
        "authorized_official_first_name": "MOHAMAD",
        "authorized_official_middle_name": "ISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-879-4877"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166443",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Cap Pharmacy 001",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Red Cap Pharmacy 001",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.