Provider Demographics
NPI:1669064861
Name:CAPOGROSSO, EUGENE ROBERT III (RPH)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:ROBERT
Last Name:CAPOGROSSO
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E 73RD ST APT 25
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5451
Mailing Address - Country:US
Mailing Address - Phone:718-594-6350
Mailing Address - Fax:
Practice Address - Street 1:1332 COMMERCE AVE FRNT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3612
Practice Address - Country:US
Practice Address - Phone:347-612-8456
Practice Address - Fax:347-328-5616
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist