Provider Demographics
NPI:1912692401
Name:SANTIBANEZ, EUGENIO JOSE (RPT, CPHT)
Entity Type:Individual
Prefix:MR
First Name:EUGENIO
Middle Name:JOSE
Last Name:SANTIBANEZ
Suffix:
Gender:M
Credentials:RPT, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W 70TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5418
Mailing Address - Country:US
Mailing Address - Phone:305-979-7930
Mailing Address - Fax:
Practice Address - Street 1:600 ANSIN BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2118
Practice Address - Country:US
Practice Address - Phone:954-874-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT34648183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician