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General NPI Number Information
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NPI Number | 1821754367
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Entity Type | Individual
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Provider Name | AUGUSTA ELIZABETH MOMODU PHARM D
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 7923A BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3302
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Country | US
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Telephone | 215-516-6544
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Fax | 215-333-3511
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Provider Business Mailing Address
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Address Line | 5 MESSINA DR
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City | SWEDESBORO
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State | NJ
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Zip | 08085-3081
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Country | US
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Telephone | 856-371-6007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP438856
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License Number State | PA
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