Healthcare Provider Details

I. General information

NPI: 1295018554
Provider Name (Legal Business Name): RONYA BALOGUN RPH, LAPC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 INTERPLEX DR STE 101
FEASTERVILLE TREVOSE PA
19053-6940
US

IV. Provider business mailing address

3845 BERKLEY RD
BENSALEM PA
19020-1403
US

V. Phone/Fax

Practice location:
  • Phone: 908-216-6764
  • Fax: 215-253-5305
Mailing address:
  • Phone: 908-216-6764
  • Fax: 215-253-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001275
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450307
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02688300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: