Provider Demographics
NPI:1710583547
Name:JADEJA, AJAYKUMAR R (RPH)
Entity Type:Individual
Prefix:MR
First Name:AJAYKUMAR
Middle Name:R
Last Name:JADEJA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:AJAY
Other - Middle Name:R
Other - Last Name:JADEJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3105 JACLAMO ST
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-3908
Mailing Address - Country:US
Mailing Address - Phone:972-896-9407
Mailing Address - Fax:
Practice Address - Street 1:606 WEST ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-875-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist