Healthcare Provider Details

I. General information

NPI: 1659477388
Provider Name (Legal Business Name): FERNANDO SANTANA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N PERIMETER RD
MALMSTROM AFB MT
59402-6701
US

IV. Provider business mailing address

900 KAPOK ST
GREAT FALLS MT
59405-8634
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-3095
  • Fax:
Mailing address:
  • Phone: 406-731-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9829
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: