Provider Demographics
NPI:1205470515
Name:TARRAZA SANTOS, ARIEL E (PHARMD)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:E
Last Name:TARRAZA SANTOS
Suffix:
Gender:M
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:CENTRO COMERCIAL PLAZA CARIBE MALL
Mailing Address - Street 2:CARR ESTATAL #2
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-270-7730
Mailing Address - Fax:
Practice Address - Street 1:CARR 863 KM 0.6, BO. PAJAROS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951
Practice Address - Country:US
Practice Address - Phone:787-620-9611
Practice Address - Fax:787-251-3335
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty