Provider Demographics
NPI:1588365498
Name:KOUAHOU, MARTINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:
Last Name:KOUAHOU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3702
Mailing Address - Country:US
Mailing Address - Phone:267-666-2356
Mailing Address - Fax:484-455-7915
Practice Address - Street 1:9014 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2606
Practice Address - Country:US
Practice Address - Phone:484-455-7915
Practice Address - Fax:484-455-7923
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist