Provider Demographics
NPI:1821139239
Name:JEBIX CORPORATION
Entity Type:Organization
Organization Name:JEBIX CORPORATION
Other - Org Name:MT OLIVET PHARMACY & MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOTAYO
Authorized Official - Middle Name:SULE
Authorized Official - Last Name:AWOTUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:202-529-7001
Mailing Address - Street 1:1809 W VIRGINIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1827
Mailing Address - Country:US
Mailing Address - Phone:202-529-7001
Mailing Address - Fax:202-529-7005
Practice Address - Street 1:1809 W VIRGINIA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1827
Practice Address - Country:US
Practice Address - Phone:202-529-7001
Practice Address - Fax:202-529-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH3139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035738300Medicaid
DC5283040001Medicare NSC