Healthcare Provider Details

I. General information

NPI: 1235617838
Provider Name (Legal Business Name): IVETTE MARIA SANTIAGO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

PO BOX 51513
TOA BAJA PR
00950-1513
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax: 787-200-2839
Mailing address:
  • Phone: 787-795-2935
  • Fax: 787-200-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3526
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: