Provider Demographics
NPI:1386913184
Name:ROBERTS, AJAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25011 ALESSANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4312
Mailing Address - Country:US
Mailing Address - Phone:951-485-1116
Mailing Address - Fax:951-485-4257
Practice Address - Street 1:25011 ALESSANDRO BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4312
Practice Address - Country:US
Practice Address - Phone:951-485-1116
Practice Address - Fax:951-485-4257
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist