Provider Demographics
NPI:1720713167
Name:PEREZ-SANTIAGO, IDALIZ (PHARMACY TECHNITIAN)
Entity Type:Individual
Prefix:
First Name:IDALIZ
Middle Name:
Last Name:PEREZ-SANTIAGO
Suffix:
Gender:F
Credentials:PHARMACY TECHNITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 2479
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9754
Mailing Address - Country:US
Mailing Address - Phone:787-245-9379
Mailing Address - Fax:
Practice Address - Street 1:BARRIO LOMAS GARCIA
Practice Address - Street 2:CARR. 165 KM. 0.2
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-245-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012263183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician