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General NPI Number Information
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NPI Number | 1598825598
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Entity Type | Individual
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Provider Name | KAYODE EBED-MELECH BALOGUN SR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/21/2022
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Provider Practice Location 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 | 19013-5967
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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 | 2409 EDGMONT AVE
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City | CHESTER
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State | PA
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Zip | 19013-4612
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Country | US
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Telephone | 267-307-0104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP033280R
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License Number State | PA
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