Provider Demographics
NPI:1790361624
Name:SANTIAGO ROSARIO, RAIZA MIGDELYS (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:MIGDELYS
Last Name:SANTIAGO ROSARIO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RAIZA
Other - Middle Name:MIGDELYS
Other - Last Name:SANTIAGO ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:AVE DE DIEGO 2550
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-762-8412
Mailing Address - Fax:
Practice Address - Street 1:1500 AVENIDA SUR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-762-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist