Provider Demographics
NPI:1013992114
Name:SANTIAGO, NOEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:PHARMACY SERVICE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-972-7673
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:PHARMACY SERVICE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-972-7673
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40735183500000X
PR5113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist