Provider Demographics
NPI:1982123410
Name:SANTANA, NYDMARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NYDMARIE
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 F.D. ROOSEVELT AVE
Mailing Address - Street 2:614
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-425-7488
Mailing Address - Fax:787-774-0555
Practice Address - Street 1:1 ROOSVELT AVE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-792-3725
Practice Address - Fax:787-774-0555
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist