MEDICARE: DR. OLIVIA TCHANQUE DOCTOR

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	RP453341	PA

General Provider Information

NPI Number	:	1760024400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVIA TCHANQUE DOCTOR

Provider Business Mailing Address
First Line	:	7223A RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3926
Country	:	US
Telephone Number	:	610-708-3858
Fax Number	:	610-708-3859

Provider Business Practice Location Address
First Line	:	7223A RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3926
Country	:	US
Telephone Number	:	610-708-3858
Fax Number	:	610-708-3859

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

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	09/23/2020

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