Healthcare Provider Details

I. General information

NPI: 1831174630
Provider Name (Legal Business Name): JUAN SANTOS-OLIVARES RPH, PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/17/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 CALLE RAMOS ANTONINI EL TUQUE
PONCE PR
00728-4806
US

IV. Provider business mailing address

A18 CALLE PALMA REAL VILLAS DEL SAGRADO CORAZON
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2805
  • Fax: 787-841-5551
Mailing address:
  • Phone: 787-647-0590
  • Fax: 787-841-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4030
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: