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NPI Code Detail

MEDICARE: DR. MARLYSE TSANGUE PHARM.D

MEDICARE: DR. MARLYSE TSANGUE PHARM.D
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
1183500000XPharmacist051290573IL

General Provider Information

NPI Number : 1427326016
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARLYSE TSANGUE PHARM.D
Provider Business Mailing Address
First Line : 1713 W SPRINGFIELD AVE
Second Line :
City : CHAMPAIGN
State : IL
Zip : 61821-3011
Country : US
Telephone Number : 217-356-2529
Fax Number : 217-356-1423
Provider Business Practice Location Address
First Line : 1713 W SPRINGFIELD AVE
Second Line :
City : CHAMPAIGN
State : IL
Zip : 61821-3011
Country : US
Telephone Number : 217-356-2529
Fax Number : 217-356-1423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2011
Last Update Date : 12/09/2011

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