Organization
MOMBA PHARMACY SERVICES LLC
Active
Other names
The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MORGAN (SPECIALIST, CUSTOMER OPS SUPPORT)
(614) 652-1509
Entity
Organization
Contact information
Practice address
1234 W MAIN ST, MONONGAHELA, PA 15063-2830
(724) 258-5055
(724) 258-7806
Mailing address
1234 W MAIN ST, MONONGAHELA, PA 15063-2830
(724) 258-5055
(724) 258-7806
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP414165L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3996432
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/02/2011
Last updated
06/27/2012
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