Provider Demographics
NPI:1093857302
Name:SANTIAGO, EDGARDO (PHARM D, CGP)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PHARM D, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS FAROLES 500 CARR. 861 BOX 185
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-999-5208
Mailing Address - Fax:
Practice Address - Street 1:MCS PLAZA 255 AVE. PONCE DE LEON, SUITE 75
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1919
Practice Address - Country:US
Practice Address - Phone:787-758-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49391835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric