Provider Demographics
NPI:1972972396
Name:THANNICKAL, BINCY ROSE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BINCY
Middle Name:ROSE
Last Name:THANNICKAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25605 HOOD WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1401
Mailing Address - Country:US
Mailing Address - Phone:818-251-0132
Mailing Address - Fax:
Practice Address - Street 1:17010 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5844
Practice Address - Country:US
Practice Address - Phone:818-360-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist