Provider Demographics
NPI:1376270652
Name:SANTOS DIAZ, LISANDRA (PHARMACY INTERN -P3)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:SANTOS DIAZ
Suffix:
Gender:F
Credentials:PHARMACY INTERN -P3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BDA FERRER
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3375
Mailing Address - Country:US
Mailing Address - Phone:787-478-9590
Mailing Address - Fax:
Practice Address - Street 1:EL JIBARO AVE AND PR 172
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist