Provider Demographics
NPI:1336761170
Name:GOMBOS, EVAN MITCHELL (PHARMD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:MITCHELL
Last Name:GOMBOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 ONEIDA CIR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4042
Mailing Address - Country:US
Mailing Address - Phone:610-413-4728
Mailing Address - Fax:
Practice Address - Street 1:5846 ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1708
Practice Address - Country:US
Practice Address - Phone:610-413-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist