=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295018554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONYA BALOGUN RPH, LAPC, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2011
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 INTERPLEX DR STE 101
-----------------------------------------------------
City | FEASTERVILLE TREVOSE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19053-6940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-216-6764
-----------------------------------------------------
Fax | 215-253-5305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3845 BERKLEY RD
-----------------------------------------------------
City | BENSALEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19020-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-216-6764
-----------------------------------------------------
Fax | 215-253-5305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP450307
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI02688300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | APC001275
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------