Provider Demographics
NPI:1417312190
Name:SANTIAGO, AIDA ESTHER
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:ESTHER
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FARMACIA SAN PABLO SAN PEDRO
Mailing Address - Street 2:CALLE UNION # 152
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:939-214-7205
Mailing Address - Fax:847-396-2748
Practice Address - Street 1:FARMACIA SAN PABLO Y SAN PEDRO
Practice Address - Street 2:152 CALLE UNION
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:939-214-7205
Practice Address - Fax:847-396-2748
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist