MEDICARE: JEBA INVESTMENTS GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy
5	3336L0003X	Long Term Care Pharmacy	PH24594	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2124954	OTHER		PK

General Provider Information

NPI Number	:	1417275694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEBA INVESTMENTS GROUP LLC

Provider Business Mailing Address
First Line	:	8802 ROCKY CREEK DR
Second Line	:	#101
City	:	TAMPA
State	:	FL
Zip	:	33615-4315
Country	:	US
Telephone Number	:	813-885-4000
Fax Number	:	813-885-4008

Provider Business Practice Location Address
First Line	:	8802 ROCKY CREEK DR STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4315
Country	:	US
Telephone Number	:	813-885-4000
Fax Number	:	813-885-4008

Authorized Official
Title or Position	:	CLINICAL PHARMACIST
Name	:	JULIUS BEN-ACQUAAH
Credential	:
Telephone Number	:	813-885-4000

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	02/20/2017

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