Provider Demographics
NPI:1104906916
Name:BUDIS, JOHN MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:BUDIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 HOGARTH TER
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2739
Mailing Address - Country:US
Mailing Address - Phone:408-739-5216
Mailing Address - Fax:
Practice Address - Street 1:900 KIELY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5329
Practice Address - Country:US
Practice Address - Phone:408-236-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist