Provider Demographics
NPI:1144582057
Name:SANTANA, WILDA G (RPH)
Entity Type:Individual
Prefix:MRS
First Name:WILDA
Middle Name:G
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:BOX 1638
Mailing Address - Street 2:HCO1
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-646-0528
Mailing Address - Fax:
Practice Address - Street 1:HC-O2
Practice Address - Street 2:BOX14850
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-808-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist