Organization
MOMBA PHARMACY SERVICES LLC
Active
Other names
Waltmire Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FRED DEPASQUALE (DEPASQUALE)
(412) 559-5082
Entity
Organization
Contact information
Practice address
1435 SPRING GARDEN AVE, PITTSBURGH, PA 15212-3711
(412) 323-1801
(412) 323-1687
Mailing address
1435 SPRING GARDEN AVE, PITTSBURGH, PA 15212-3711
(412) 323-1801
(412) 323-1687
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP411539L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102673880
—
PA
01
—
2149578
PK
—
Enumeration date
12/02/2014
Last updated
07/20/2015
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