Provider Demographics
NPI:1023345865
Name:BURGIO, JUDY LYNN (RPH, CN)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:BURGIO
Suffix:
Gender:F
Credentials:RPH, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MILLER AVE
Mailing Address - Street 2:PMB 162
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1927
Mailing Address - Country:US
Mailing Address - Phone:415-383-1908
Mailing Address - Fax:415-389-8566
Practice Address - Street 1:305 MORNING SUN AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3526
Practice Address - Country:US
Practice Address - Phone:415-383-1908
Practice Address - Fax:415-389-8566
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH324001835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support