Provider Demographics
NPI:1821754367
Name:MOMODU, AUGUSTA ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTA
Middle Name:ELIZABETH
Last Name:MOMODU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MESSINA DR
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3081
Mailing Address - Country:US
Mailing Address - Phone:856-371-6007
Mailing Address - Fax:
Practice Address - Street 1:7923A BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3302
Practice Address - Country:US
Practice Address - Phone:215-516-6544
Practice Address - Fax:215-333-3511
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist