Provider Demographics
NPI:1760024400
Name:TCHANQUE, OLIVIA (DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:TCHANQUE
Suffix:
Gender:F
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223A RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3926
Mailing Address - Country:US
Mailing Address - Phone:610-708-3858
Mailing Address - Fax:610-708-3859
Practice Address - Street 1:7223A RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3926
Practice Address - Country:US
Practice Address - Phone:610-708-3858
Practice Address - Fax:610-708-3859
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist