MEDICARE: OLIVE HEALTHCARE INC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1396349122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE HEALTHCARE INC

Provider Business Mailing Address
First Line	:	3908 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4400
Country	:	US
Telephone Number	:	215-245-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4400
Country	:	US
Telephone Number	:	215-245-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AHMED NAWAZ
Credential	:
Telephone Number	:	215-245-2020

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	05/07/2021

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Directions to “OLIVE HEALTHCARE INC ” Practice Location

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