Provider Demographics
NPI:1831174630
Name:SANTOS-OLIVARES, JUAN (RPH, PHARM D)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:SANTOS-OLIVARES
Suffix:
Gender:M
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A18 CALLE PALMA REAL
Mailing Address - Street 2:VILLAS DEL SAGRADO CORAZON
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-647-0590
Mailing Address - Fax:787-841-5551
Practice Address - Street 1:553 CALLE RAMOS ANTONINI
Practice Address - Street 2:EL TUQUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4806
Practice Address - Country:US
Practice Address - Phone:787-844-2805
Practice Address - Fax:787-841-5551
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0417OtherVACCINE PROVIDER
PR4030OtherSTATE LICENSE