Provider Demographics
NPI:1710526272
Name:CORDERO SANTIAGO, JOSUE FRANCISCO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:FRANCISCO
Last Name:CORDERO SANTIAGO
Suffix:
Gender:M
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:HC 01 BOX 3479
Mailing Address - Street 2:CARR. 119 KM. 13.2 BO. PIEDRA GORDA
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:787-309-1231
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA GLORIANA CARR. #2 KM 96.8 BARRIO COCOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist