Provider Demographics
NPI:1336541689
Name:SANTOSVARGAS, EDGARDO
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:SANTOSVARGAS
Suffix:
Gender:M
Credentials:
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 203
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31301-0203
Mailing Address - Country:US
Mailing Address - Phone:912-435-5426
Mailing Address - Fax:912-435-5807
Practice Address - Street 1:947 ELMA G MILES PKWY
Practice Address - Street 2:LOT 19
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4538
Practice Address - Country:US
Practice Address - Phone:912-435-5426
Practice Address - Fax:912-435-5807
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician