Provider Demographics
NPI:1578737672
Name:SANTIAGO, CARMEN N
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:N
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:URB. LOS ROSALES 1
Mailing Address - Street 2:5TA. AVE. 21
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0000
Mailing Address - Country:US
Mailing Address - Phone:787-854-1516
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS ROSALES 1
Practice Address - Street 2:5TA. AVE. 21
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist