MEDICARE: MRS. BINCY ROSE THANNICKAL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	60683	CA

General Provider Information

NPI Number	:	1972972396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BINCY ROSE THANNICKAL RPH

Provider Business Mailing Address
First Line	:	25605 HOOD WAY
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-1401
Country	:	US
Telephone Number	:	818-251-0132
Fax Number	:

Provider Business Practice Location Address
First Line	:	17010 CHATSWORTH ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5844
Country	:	US
Telephone Number	:	818-360-0871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	07/29/2022

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