Provider Demographics
NPI:1710270780
Name:SANTANA, IRMARY (4624)
Entity Type:Individual
Prefix:MRS
First Name:IRMARY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:4624
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CAMINO DEL GUAMA
Mailing Address - Street 2:SABANERA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-249-6496
Mailing Address - Fax:
Practice Address - Street 1:35 LOS DOMINICOS AVE.
Practice Address - Street 2:WALGREENS #0082
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-2050
Practice Address - Fax:787-795-2052
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist