Provider Demographics
NPI:1952893299
Name:AYETTE, ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:AYETTE
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 1:9000 N MAIN ST
Mailing Address - Street 2:MVHN INPATIENT PHARMACY
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415
Mailing Address - Country:US
Mailing Address - Phone:937-734-5838
Mailing Address - Fax:937-734-5949
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:MVHN INPATIENT PHARMACY
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415
Practice Address - Country:US
Practice Address - Phone:937-734-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223744333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03223744OtherOHIO STATE BOARD OF PHARMACY