Provider Demographics
NPI:1497030332
Name:GAJERA, AJAYKUMAR J (RPH)
Entity Type:Individual
Prefix:
First Name:AJAYKUMAR
Middle Name:J
Last Name:GAJERA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1721
Mailing Address - Country:US
Mailing Address - Phone:810-653-4020
Mailing Address - Fax:810-653-9174
Practice Address - Street 1:427 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2759
Practice Address - Country:US
Practice Address - Phone:989-720-4545
Practice Address - Fax:989-720-4546
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist