# STATE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205961489
- **Authorized official:** DR. MARIE NKINANG BIBUM PHARM D (PRESIDENT)
- **Authorized official phone:** (202) 610-2100

## Contact information

- **Practice address:** 2041 MARTIN LUTHER KING AVE, SUITE 100, SE WASHINGTON, DC 20020
- **Practice address phone:** (202) 610-2100
- **Practice address fax:** (202) 610-1078
- **Mailing address:** 2041 MARTIN LUTHER KING AVE, SUITE 100, SE WASHINGTON, DC 20020
- **Mailing address phone:** (202) 610-2100
- **Mailing address fax:** (202) 610-1078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | RX0300330 | DC | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RX0300330 | DC | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 12/01/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 034828700 | — | DC |
| 05 | — | 035360800 | — | DC |