Healthcare Provider Details

I. General information

NPI: 1568779106
Provider Name (Legal Business Name): ANA CORAZON SANTOS BORJA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 REYNOLDA RD
WINSTON SALEM NC
27106-2229
US

IV. Provider business mailing address

3601 REYNOLDA RD
WINSTON SALEM NC
27106-2229
US

V. Phone/Fax

Practice location:
  • Phone: 336-924-9366
  • Fax: 336-924-5345
Mailing address:
  • Phone: 336-924-9366
  • Fax: 336-924-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: