Provider Demographics
NPI:1295347516
Name:KAYTON PHARMACY LLC
Entity type:Organization
Organization Name:KAYTON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEFOLAKE
Authorized Official - Middle Name:TOLULOPE
Authorized Official - Last Name:OJEMUYIWA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-600-5666
Mailing Address - Street 1:PO BOX 43701
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-0701
Mailing Address - Country:US
Mailing Address - Phone:404-600-5666
Mailing Address - Fax:
Practice Address - Street 1:541 FOREST PKWY STE 4
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2147
Practice Address - Country:US
Practice Address - Phone:404-600-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAYTON PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03154268AMedicaid