Provider Demographics
NPI:1275817405
Name:ABEJIDE, AYODEJI EYITAYO
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:EYITAYO
Last Name:ABEJIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48607 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5588
Mailing Address - Country:US
Mailing Address - Phone:586-945-1778
Mailing Address - Fax:
Practice Address - Street 1:420 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1425
Practice Address - Country:US
Practice Address - Phone:248-481-9004
Practice Address - Fax:248-481-9168
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist