Provider Demographics
NPI:1386053353
Name:SANTAMARIA, RITA
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SANTAMARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 SR 507 SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7605
Mailing Address - Country:US
Mailing Address - Phone:360-400-8062
Mailing Address - Fax:
Practice Address - Street 1:17100 SR 507 SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7605
Practice Address - Country:US
Practice Address - Phone:360-400-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60145951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist