Provider Demographics
NPI:1912788654
Name:TOLENTINO PACHECO, SANTIAGO MIGUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:MIGUEL
Last Name:TOLENTINO PACHECO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 E WASHINGTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1864 E WASHINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1667
Practice Address - Country:US
Practice Address - Phone:626-398-1698
Practice Address - Fax:626-398-9860
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH87762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist