Provider Demographics
NPI:1295018554
Name:BALOGUN, RONYA (RPH)
Entity Type:Individual
Prefix:
First Name:RONYA
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 MARSHALL ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:908-216-6764
Mailing Address - Fax:215-253-5305
Practice Address - Street 1:9150 MARSHALL ST STE 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2217
Practice Address - Country:US
Practice Address - Phone:908-216-6764
Practice Address - Fax:215-253-5305
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02688300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist