Provider Demographics
NPI:1558533950
Name:SANTIAGO, GRISEL GRISEL I (PHARMACIST)
Entity Type:Individual
Prefix:MISS
First Name:GRISEL
Middle Name:GRISEL
Last Name:SANTIAGO
Suffix:I
Gender:F
Credentials:PHARMACIST
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 141602
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1602
Mailing Address - Country:US
Mailing Address - Phone:787-878-0002
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 INT 490
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist