Provider Demographics
NPI:1508309253
Name:JOEDAT INTERNATIONAL INC
Entity Type:Organization
Organization Name:JOEDAT INTERNATIONAL INC
Other - Org Name:NORTH CAPITOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:571-309-2816
Mailing Address - Street 1:2205 DILORETA DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4139
Mailing Address - Country:US
Mailing Address - Phone:571-309-2816
Mailing Address - Fax:202-299-0565
Practice Address - Street 1:1516 N CAPITOL ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3344
Practice Address - Country:US
Practice Address - Phone:202-241-1491
Practice Address - Fax:202-299-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332BX2000X, 333600000X, 3336C0004X, 3336S0011X
DCRX00001103336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016262056Medicaid
DC1508309253Medicaid
2166593OtherPK