Provider Demographics
NPI:1033320171
Name:MOMBERGER, LINDA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:MOMBERGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PICKETT STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CASTILE
Mailing Address - State:NY
Mailing Address - Zip Code:14427-9707
Mailing Address - Country:US
Mailing Address - Phone:585-493-2028
Mailing Address - Fax:
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1025
Practice Address - Country:US
Practice Address - Phone:585-786-2233
Practice Address - Fax:585-786-1240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036771-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist