Provider Demographics
NPI:1154866911
Name:MORENO, SANTIAGO JOSE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:JOSE
Last Name:MORENO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8802 NW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6239
Mailing Address - Country:US
Mailing Address - Phone:786-247-6601
Mailing Address - Fax:
Practice Address - Street 1:8341 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2029
Practice Address - Country:US
Practice Address - Phone:305-266-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist