Provider Demographics
NPI:1093302838
Name:SANTANA, JOSEFITA MAGDELENA (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEFITA
Middle Name:MAGDELENA
Last Name:SANTANA
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:PO BOX 23674
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-3674
Mailing Address - Country:US
Mailing Address - Phone:505-980-6530
Mailing Address - Fax:
Practice Address - Street 1:2907 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2310
Practice Address - Country:US
Practice Address - Phone:505-471-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0050321835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy