Provider Demographics
NPI:1639694698
Name:TICKOO, SUNIL KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:KUMAR
Last Name:TICKOO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2112
Mailing Address - Country:US
Mailing Address - Phone:203-562-4447
Mailing Address - Fax:
Practice Address - Street 1:BERNEYS PHARMACY
Practice Address - Street 2:615 HOWARD AVE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-2112
Practice Address - Country:US
Practice Address - Phone:203-562-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist