Provider Demographics
NPI:1689494304
Name:TICKLE, VRUSHALI
Entity type:Individual
Prefix:MRS
First Name:VRUSHALI
Middle Name:
Last Name:TICKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3027
Mailing Address - Country:US
Mailing Address - Phone:571-337-5437
Mailing Address - Fax:
Practice Address - Street 1:6341 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3027
Practice Address - Country:US
Practice Address - Phone:571-337-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT19160183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician