Healthcare Provider Details

I. General information

NPI: 1235857301
Provider Name (Legal Business Name): JESSICA NICOLE RIOS - SANTIAGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VIA PEDREGAL MONTECILLO 2 APT. 2406
TUJILLO ALTO PR
00976
US

IV. Provider business mailing address

2 VIA PEDREGAL MONTECILLO 2 APT. 2406
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-3657
  • Fax:
Mailing address:
  • Phone: 787-505-3657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1458237
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: