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Organization
STATE PHARMACY
Active
Organization
STATE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIE NKINANG BIBUM PHARM D (PRESIDENT)
(202) 610-2100
Entity
Organization
Contact information
Practice address
2041 MARTIN LUTHER KING AVE, SUITE 100, SE WASHINGTON, DC 20020
(202) 610-2100
(202) 610-1078
Mailing address
2041 MARTIN LUTHER KING AVE, SUITE 100, SE WASHINGTON, DC 20020
(202) 610-2100
(202) 610-1078
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
RX0300330
DC
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RX0300330
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034828700
—
DC
05
—
035360800
—
DC
Enumeration date
02/21/2007
Last updated
12/01/2020
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