Provider Demographics
NPI:1891238747
Name:SANTOS, MARKPAUL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARKPAUL
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PHARM D
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 804
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-0804
Mailing Address - Country:US
Mailing Address - Phone:928-386-3461
Mailing Address - Fax:
Practice Address - Street 1:121 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9030
Practice Address - Country:US
Practice Address - Phone:509-447-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60632894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist