Provider Demographics
NPI:1922750843
Name:TICKLE, MAHESH YASHWANT
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:YASHWANT
Last Name:TICKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 OXON HILL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3138
Mailing Address - Country:US
Mailing Address - Phone:301-485-0000
Mailing Address - Fax:301-485-1259
Practice Address - Street 1:6196 OXON HILL RD STE 130
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3138
Practice Address - Country:US
Practice Address - Phone:301-485-0000
Practice Address - Fax:301-485-1259
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist