MEDICARE: DIANE TSCHERTAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03221376	OH

General Provider Information

NPI Number	:	1134655293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE TSCHERTAN RPH

Provider Business Mailing Address
First Line	:	2474 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2474 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3929
Country	:	US
Telephone Number	:	614-875-0596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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