Provider Demographics
NPI:1295242477
Name:AJUEYITSI HOLDINGS INC
Entity type:Organization
Organization Name:AJUEYITSI HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:770-866-9016
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:770-866-9016
Mailing Address - Fax:678-391-1141
Practice Address - Street 1:579 CONCORD RD SE STE 400
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2627
Practice Address - Country:US
Practice Address - Phone:770-989-1280
Practice Address - Fax:770-989-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy