Provider Demographics
NPI:1972934081
Name:SANTIAGO, STARLETTE
Entity Type:Individual
Prefix:
First Name:STARLETTE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STARLETTE
Other - Middle Name:
Other - Last Name:MARINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5431 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5431 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1918
Practice Address - Country:US
Practice Address - Phone:503-245-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist