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General NPI Number Information
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NPI Number | 1336467836
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Entity Type | Organization
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Legal Business Name | AVENUE HEALTHCARE ENTERPRISES INC
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 1111 AVENUE OF THE STATES STORE #2
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City | CHESTER
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State | PA
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Zip | 19013
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Country | US
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Telephone | 484-816-0344
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Fax | 484-816-0296
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Provider Business Mailing Address
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Address Line | 1111 AVENUE OF THE STATES
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City | CHESTER
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State | PA
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Zip | 19013
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Country | US
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Telephone | 484-816-0344
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Fax | 484-816-0296
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. KAYODE EBED-MELECH BALOGUN SR.
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Credential | R.PH, M.SC
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Telephone | 484-816-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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