Provider Demographics
NPI:1184834970
Name:SANTIAGO, MARINELLY
Entity Type:Individual
Prefix:MRS
First Name:MARINELLY
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARINELLY
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:99 GUILLERMO RIEFKOHL ST.
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0697
Mailing Address - Country:US
Mailing Address - Phone:787-839-4320
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:99 GUILLERMO RIEFKOHL ST.
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-0697
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:787-271-0004
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4379183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4379OtherPHARMACY LICENSE