Healthcare Provider Details

I. General information

NPI: 1669210720
Provider Name (Legal Business Name): ENEISHA I SANTIAGO-VELEZ PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHEAST CORNER OF CALLE PUBLICA & PR 2
VEGA BAJA PR
00693
US

IV. Provider business mailing address

566 PARCELAS JAUCA
SANTA ISABEL PR
00757
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-3044
  • Fax:
Mailing address:
  • Phone: 787-432-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006751
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: