Provider Demographics
NPI:1174687487
Name:BOLAJI, TAI H (PHARMD, CDE)
Entity type:Individual
Prefix:DR
First Name:TAI
Middle Name:H
Last Name:BOLAJI
Suffix:
Gender:M
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E. ANDREWS AVENUE
Mailing Address - Street 2:US ARMY AEROMEDICAL CENTER
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-255-7177
Mailing Address - Fax:334-255-7176
Practice Address - Street 1:301 E. ANDREWS AVENUE
Practice Address - Street 2:US ARMY AEROMEDICAL CENTER
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-7177
Practice Address - Fax:334-255-7176
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15159261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAVIATIONOtherMILITARY