Provider Demographics
NPI:1083637532
Name:SANTIAGO, NILZA I (RPH)
Entity Type:Individual
Prefix:
First Name:NILZA
Middle Name:I
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SA60 PLAZA 3
Mailing Address - Street 2:LA MANSION
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4850
Mailing Address - Country:US
Mailing Address - Phone:787-370-2526
Mailing Address - Fax:787-870-7939
Practice Address - Street 1:B35 CALLE 6
Practice Address - Street 2:URB SAN FERNANDO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2205
Practice Address - Country:US
Practice Address - Phone:787-370-2526
Practice Address - Fax:787-870-7939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist