| Doctor Name: | ENDAH SUSILOWATY |
| NPI Number: | 1164624474 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHARMACY TECHNICIAN |
| License Number: | TCH 69355 |
| Business Practice Address: | 121 Tunstead Ave San Anselmo, CA - 949602616 |
| Business Phone Number: | 4154541451 |
| Business Fax Number: | 4154542865 |
| Mailing Address: | 639 Geary St Apt 505, SAN FRANCISCO |
| State: | CA |
| Postal Code: | 941021674 |
| Phone Number: | 4154541451 |
| Fax Number: | 4154542865 |
| NPI Enumeration Date: | 05/31/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | TCH 69355 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |