MEDICARE: DR. MARTINE KOUAHOU PHARMD

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	RP442007	PA

General Provider Information

NPI Number	:	1588365498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTINE KOUAHOU PHARMD

Provider Business Mailing Address
First Line	:	7015 HAZEL AVE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3702
Country	:	US
Telephone Number	:	267-666-2356
Fax Number	:	484-455-7915

Provider Business Practice Location Address
First Line	:	9014 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2606
Country	:	US
Telephone Number	:	484-455-7915
Fax Number	:	484-455-7923

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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