Provider Demographics
NPI:1740605591
Name:GONZALEZ SANTIAGO, LYMARTA GUADALUPE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYMARTA
Middle Name:GUADALUPE
Last Name:GONZALEZ SANTIAGO
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:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0080
Mailing Address - Country:US
Mailing Address - Phone:787-349-0464
Mailing Address - Fax:
Practice Address - Street 1:PASEO DEL FARO & PR 3 KM. 130.1 CUATRO C
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-839-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist