Provider Demographics
NPI:1508171430
Name:BAJON, WAYNE JOSEPH (R PH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:JOSEPH
Last Name:BAJON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14444 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1319
Mailing Address - Country:US
Mailing Address - Phone:225-753-1499
Mailing Address - Fax:
Practice Address - Street 1:14444 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1319
Practice Address - Country:US
Practice Address - Phone:225-753-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist