Provider Demographics
NPI:1659963296
Name:BERRETTINI, JUDITH ANN
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BERRETTINI
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 1:709 THERESA CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4042
Mailing Address - Country:US
Mailing Address - Phone:281-486-4864
Mailing Address - Fax:
Practice Address - Street 1:7001 WYOMING SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4317
Practice Address - Country:US
Practice Address - Phone:512-716-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist