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General NPI Number Information
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NPI Number | 1275817405
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Entity Type | Individual
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Provider Name | AYODEJI EYITAYO ABEJIDE
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Gender | Male
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 420 W HURON ST
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City | PONTIAC
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State | MI
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Zip | 48341-1425
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Country | US
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Telephone | 248-481-9004
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Fax | 248-481-9168
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Provider Business Mailing Address
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Address Line | 48607 CROSS CREEK DR
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City | MACOMB
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State | MI
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Zip | 48044-5588
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Country | US
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Telephone | 586-945-1778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302035314
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License Number State | MI
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