Provider Demographics
NPI:1639464399
Name:MASSARI SANTOS, KRISTIE MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:MARIE
Last Name:MASSARI SANTOS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 AVENIDA MARUCA
Mailing Address - Street 2:WALGREENS #165
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-812-5980
Mailing Address - Fax:
Practice Address - Street 1:2706 AVENIDA MARUCA
Practice Address - Street 2:WALGREENS #165
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-812-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist