Provider Demographics
NPI:1790825024
Name:SANTIAGO, ZAIDA (RPH)
Entity Type:Individual
Prefix:
First Name:ZAIDA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 CALLE TOMAS AGRAIT
Mailing Address - Street 2:CLUB MANOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1227 CALLE TOMAS AGRAIT
Practice Address - Street 2:CLUB MANOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4344
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist