Provider Demographics
NPI:1821118233
Name:SANTIAGO, MARISOL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name: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 1:2631 CALLE CIDRA
Mailing Address - Street 2:LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2728
Mailing Address - Country:US
Mailing Address - Phone:787-202-7816
Mailing Address - Fax:787-848-0109
Practice Address - Street 1:HC 2 BOX 5171
Practice Address - Street 2:CARR. #149 KM. 57.4 BO. TIERRA SANTA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-9862
Practice Address - Country:US
Practice Address - Phone:787-202-7816
Practice Address - Fax:787-848-0109
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4626183500000X
FLPS43121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist