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General NPI Number Information
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NPI Number | 1902457286
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Entity Type | Individual
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Provider Name | KATHLEEN ANN TICKNER RPH
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 1736 E AVENIDA DE LOS ARBOLES
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-1307
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Country | US
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Telephone | 805-493-8001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5384
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City | CHATSWORTH
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State | CA
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Zip | 91313-5384
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Country | US
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Telephone | 818-257-2570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 27003
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License Number State | CA
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