Provider Demographics
NPI:1619019338
Name:FARMACIA SANTIAGO INC
Entity Type:Organization
Organization Name:FARMACIA SANTIAGO INC
Other - Org Name:FARMACIA SANTIAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXC DIR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-884-1113
Mailing Address - Street 1:PO BOX 3446
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3446
Mailing Address - Country:US
Mailing Address - Phone:787-884-1114
Mailing Address - Fax:787-884-0125
Practice Address - Street 1:CARR 670 KM 1.8 BO COTTO NORTE INTERIOR
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-1114
Practice Address - Fax:787-884-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12F26933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025587OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PR6543680001Medicare NSC