Provider Demographics
NPI:1518277615
Name:TAWNEY, JUDI P
Entity Type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:P
Last Name:TAWNEY
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 1:701 E BLITHEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1526
Mailing Address - Country:US
Mailing Address - Phone:415-388-2546
Mailing Address - Fax:415-388-1326
Practice Address - Street 1:701 E BLITHEDALE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1526
Practice Address - Country:US
Practice Address - Phone:415-388-2546
Practice Address - Fax:415-388-1326
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist