Provider Demographics
NPI:1306181052
Name:SANTOS, ALLAN MANUEL (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:MANUEL
Last Name:SANTOS
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 E. VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2004
Mailing Address - Country:US
Mailing Address - Phone:941-480-1889
Mailing Address - Fax:941-480-1740
Practice Address - Street 1:1445 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3064
Practice Address - Country:US
Practice Address - Phone:941-480-1889
Practice Address - Fax:941-480-1740
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist