Provider Demographics
NPI:1619259512
Name:SY-JUDILLA, BETTY RANIT (RPH)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:RANIT
Last Name:SY-JUDILLA
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 1:2238 WESTBOROUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5405
Mailing Address - Country:US
Mailing Address - Phone:650-873-0551
Mailing Address - Fax:
Practice Address - Street 1:2238 WESTBOROUGH BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5405
Practice Address - Country:US
Practice Address - Phone:650-873-0551
Practice Address - Fax:650-873-0234
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist