Provider Demographics
NPI:1568779106
Name:BORJA, ANA CORAZON SANTOS (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANA CORAZON
Middle Name:SANTOS
Last Name:BORJA
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 1:3601 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2229
Mailing Address - Country:US
Mailing Address - Phone:336-924-9366
Mailing Address - Fax:336-924-5345
Practice Address - Street 1:3601 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2229
Practice Address - Country:US
Practice Address - Phone:336-924-9366
Practice Address - Fax:336-924-5345
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist