Provider Demographics
NPI:1619378197
Name:SANTIAGO RIOS, AMANDA D (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:SANTIAGO RIOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B7 CALLE MADRE PERLA
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2125
Mailing Address - Country:US
Mailing Address - Phone:787-249-0863
Mailing Address - Fax:
Practice Address - Street 1:35 AVE LOS DOMINICOS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3400
Practice Address - Country:US
Practice Address - Phone:787-795-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6203OtherSTATE LICENCE