Momba Pharmacy Services LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP411539L Issued in PA

Legal business name

MOMBA PHARMACY SERVICES LLC

Practice address

1435 Spring Garden Ave
Pittsburgh, PA 15212-3711

Phone

(412) 323-1801

Fax

(412) 323-1687

NPI assigned

Dec 2, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred Depasquale

Title

Depasquale

Phone

(412) 559-5082

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Waltmire Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1386041655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 SPRING GARDEN AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152123711",
            "telephone_number": "412-323-1801",
            "fax_number": "412-323-1687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 SPRING GARDEN AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152123711",
            "telephone_number": "412-323-1801",
            "fax_number": "412-323-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMBA PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "DEPASQUALE",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "DEPASQUALE",
        "authorized_official_telephone_number": "412-559-5082"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP411539L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102673880",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149578",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waltmire Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gregory Molter
• Edward Molyneaux, M.P.T.
• Ryan John Molz
• Christian M Molzahn, MD
• Kenechukwu Momah, M.D.
• Momba Pharmacy Services LLC
• Matthew Momich, OPTICIAN
• Katerina Momiroska, LMSW
• Salamatu Momoh, MD
• Jeremiah David Momper, PHARMD

• Community/Retail Pharmacy in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.