Provider Demographics
NPI:1083328108
Name:SANTIAGO, ISMAEL DEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:DEAN
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 BULEVAR SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2246
Mailing Address - Country:US
Mailing Address - Phone:787-672-4287
Mailing Address - Fax:
Practice Address - Street 1:282 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3921
Practice Address - Country:US
Practice Address - Phone:787-705-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1463197OtherNATIONAL ASSOCIATION BOARDS OF PHARMACY
PR008002OtherPUERTO RICO PHARMACY LICENSE