Provider Demographics
NPI:1871659052
Name:AJAYI, CLEM (RPH)
Entity Type:Individual
Prefix:
First Name:CLEM
Middle Name:
Last Name:AJAYI
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 1:12798 BAY SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7964
Mailing Address - Country:US
Mailing Address - Phone:760-949-8955
Mailing Address - Fax:
Practice Address - Street 1:14829 7TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4009
Practice Address - Country:US
Practice Address - Phone:760-245-3518
Practice Address - Fax:760-245-1662
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA046140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA046140OtherCAL LICENSE NUMBER