Healthcare Provider Details

I. General information

NPI: 1902714397
Provider Name (Legal Business Name): KABONGO BALUFU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 N HIGH ST
COLUMBUS OH
43202-1121
US

IV. Provider business mailing address

5016 FARMHOUSE RD
SOUTH BLOOMFIELD OH
43103-9250
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-5607
  • Fax: 614-267-4536
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03445089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: