Active NPI
Ayodeji Eyitayo Abejide
- Pharmacist
- Pontiac, MI
National Provider Identifier
1275817405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302035314
- Practice address
- 420 W Huron St
Pontiac, MI 48341-1425 - Phone
- (248) 481-9004
- Fax
- (248) 481-9168
- NPI assigned
- Oct 6, 2011
- Last updated
- Jan 30, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302035314 | MI | Primary |
Addresses
Primary practice location
420 W Huron St
Pontiac, MI 48341-1425
Mailing address
48607 Cross Creek Dr
Macomb, MI 48044-5588
Phone (586) 945-1778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302035314 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omega Pharmacy LLC | Current | Accepting new patients | |
| Omega Pharmacy LLC | Current | Accepting new patients |
Locations
420 W Huron St
Pontiac, MI 48341
Phone (248) 481-9004
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611964800000",
"number": "1275817405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48607 CROSS CREEK DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480445588",
"telephone_number": "586-945-1778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W HURON ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411425",
"telephone_number": "248-481-9004",
"fax_number": "248-481-9168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABEJIDE",
"first_name": "AYODEJI",
"middle_name": "EYITAYO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-06",
"last_updated": "2021-01-30",
"certification_date": "2021-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302035314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.