Provider Demographics
NPI:1619128493
Name:AJUEYITST HOLDINGS INC
Entity Type:Organization
Organization Name:AJUEYITST HOLDINGS INC
Other - Org Name:D & B PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:AJUEYITSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-391-1139
Mailing Address - Street 1:PO BOX 5158
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0003
Mailing Address - Country:US
Mailing Address - Phone:678-391-1140
Mailing Address - Fax:678-391-1141
Practice Address - Street 1:9459 HIGHWAY 5 STE U
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1539
Practice Address - Country:US
Practice Address - Phone:678-391-1139
Practice Address - Fax:678-391-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
GAPHRE0095183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117366OtherPK