Healthcare Provider Details

I. General information

NPI: 1477694511
Provider Name (Legal Business Name): MILDRED NOEMI SANTIAGO R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE GEORGETTI
BARCELONETA PR
00617-2712
US

IV. Provider business mailing address

9 CALLE GEORGETTI
BARCELONETA PR
00617-2712
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-3474
  • Fax: 787-846-0219
Mailing address:
  • Phone: 787-846-3474
  • Fax: 787-796-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1857
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1857
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerREGISTER PHARMACIST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: