Provider Demographics
NPI:1326384900
Name:SANTIAGO, YOLANDA TIU (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:TIU
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 1:2497 SE BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1246
Mailing Address - Country:US
Mailing Address - Phone:503-669-4233
Mailing Address - Fax:503-669-4238
Practice Address - Street 1:2497 SE BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1246
Practice Address - Country:US
Practice Address - Phone:503-669-4233
Practice Address - Fax:503-669-4238
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5786OtherOREGON PHARMACIST LICENSE