Provider Demographics
NPI:1326102245
Name:MOLINA, SANTIAGO
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:MOLINA
Suffix:
Gender:M
Credentials:
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 528
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0528
Mailing Address - Country:US
Mailing Address - Phone:787-876-1927
Mailing Address - Fax:787-876-1927
Practice Address - Street 1:FARMACIA MEDIANIA 187
Practice Address - Street 2:BOX 528
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-0528
Practice Address - Country:US
Practice Address - Phone:787-876-1927
Practice Address - Fax:787-876-1927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-0629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist