Provider Demographics
NPI:1275654790
Name:GONZALEZ & SANTIAGO INC
Entity Type:Organization
Organization Name:GONZALEZ & SANTIAGO INC
Other - Org Name:LA NUEVA FARMACIA GONZALEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-879-4744
Mailing Address - Street 1:152 JOSE RODRIGUEZ IRIZARRY STE 101
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-879-4744
Mailing Address - Fax:787-879-4744
Practice Address - Street 1:31 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3034
Practice Address - Country:US
Practice Address - Phone:787-847-3045
Practice Address - Fax:787-847-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PR18-F-33753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128676OtherPK