Provider Demographics
NPI:1861738932
Name:AJAYI, NANETTE HARRIS
Entity type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:HARRIS
Last Name:AJAYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 ROCK CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-3124
Mailing Address - Country:US
Mailing Address - Phone:469-231-4286
Mailing Address - Fax:
Practice Address - Street 1:6326 ROCK CANYON TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-3124
Practice Address - Country:US
Practice Address - Phone:469-231-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist