Provider Demographics
NPI:1063165629
Name:SANTIAGO, EILEEN (RPH)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0543
Mailing Address - Country:US
Mailing Address - Phone:787-868-9495
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE COLON STE 15
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3167
Practice Address - Country:US
Practice Address - Phone:787-868-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240573183500000X
PR6990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist