Provider Demographics
NPI:1164552584
Name:SANTIAGO, MIRTA (RPH)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:SANTIAGO
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:A11 CALLE 1
Mailing Address - Street 2:URB SANTA PAULA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6602
Mailing Address - Country:US
Mailing Address - Phone:787-790-2684
Mailing Address - Fax:787-720-2419
Practice Address - Street 1:AVE. ESMERALDA
Practice Address - Street 2:CTRO. COM. PONCE DE LEON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-720-4035
Practice Address - Fax:787-720-2419
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist