Provider Demographics
NPI:1235617838
Name:SANTIAGO, IVETTE MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:MARIA
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:PO BOX 51513
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1513
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:787-200-2839
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-200-2839
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051168OtherPR BOARD OF PHARMACY