Provider Demographics
NPI:1992377915
Name:SANTIAGO, VICTOR M JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:SANTIAGO
Suffix:JR
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 1:12755 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-3714
Mailing Address - Country:US
Mailing Address - Phone:305-970-7076
Mailing Address - Fax:
Practice Address - Street 1:11000 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-1704
Practice Address - Country:US
Practice Address - Phone:954-441-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist