Provider Demographics
NPI:1578577698
Name:SANTIAGO, YANIRA I (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YANIRA
Middle Name:I
Last Name: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:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0164
Mailing Address - Country:US
Mailing Address - Phone:787-818-5658
Mailing Address - Fax:
Practice Address - Street 1:CARR 109 KM 26.7
Practice Address - Street 2:BO. CULEBRINA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4582183500000X
PR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes183500000XPharmacy Service ProvidersPharmacist