Provider Demographics
NPI:1285666339
Name:SANTOS, WANDA IVELISSE (RPH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:IVELISSE
Last Name:SANTOS
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:URB.MANSIONES DE MONTECASINO II 599 CALLE REINITA
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2256
Mailing Address - Country:US
Mailing Address - Phone:939-630-4916
Mailing Address - Fax:787-252-3757
Practice Address - Street 1:FARMACIAS PLAZA 15 AVE. LOS DOMINICOS MIRAFLORES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-797-7467
Practice Address - Fax:787-797-2650
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist