Provider Demographics
NPI:1538647334
Name:GINES SANTIAGO, ALBA (RPH)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:GINES 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 1:1345 SE 42ND DR
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5024
Mailing Address - Country:US
Mailing Address - Phone:407-590-5107
Mailing Address - Fax:
Practice Address - Street 1:4001 SW 30TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1907
Practice Address - Country:US
Practice Address - Phone:352-339-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist