Provider Demographics
NPI:1578988770
Name:BALOGUN, DOLAPO
Entity type:Individual
Prefix:
First Name:DOLAPO
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4605
Mailing Address - Country:US
Mailing Address - Phone:917-492-1038
Mailing Address - Fax:917-492-1099
Practice Address - Street 1:1915 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4605
Practice Address - Country:US
Practice Address - Phone:917-492-1038
Practice Address - Fax:917-492-1099
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058916183500000X
NY8423834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist