Provider Demographics
NPI:1801173810
Name:CHANEY, OLIVIA BROOKE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:BROOKE
Last Name:CHANEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13404 E TALLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1766
Mailing Address - Country:US
Mailing Address - Phone:316-617-4171
Mailing Address - Fax:
Practice Address - Street 1:13404 E TALLOWOOD DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-1766
Practice Address - Country:US
Practice Address - Phone:316-617-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist