Provider Demographics
NPI:1093926636
Name:SANTIAGO, LYDIA MAGDALENA
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:MAGDALENA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARGINAL MARTINEZ NADAL #100
Mailing Address - Street 2:GRANADA PARK, BOX 216
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-782-0350
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA EL AMAL #10
Practice Address - Street 2:PLAZA CAPARRA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-782-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist