Provider Demographics
NPI:1649961467
Name:SANTOS, ROBERTO (RPH)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:SANTOS
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 1:2208 N BIG SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-8823
Mailing Address - Country:US
Mailing Address - Phone:432-682-9501
Mailing Address - Fax:432-682-9497
Practice Address - Street 1:2208 N BIG SPRING ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-8823
Practice Address - Country:US
Practice Address - Phone:432-682-9501
Practice Address - Fax:432-682-9497
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist