Provider Demographics
NPI:1386926178
Name:SANTILLO, SARAH ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:SANTILLO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BROADWAY AVE
Mailing Address - Street 2:TARGET 231
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92021
Mailing Address - Country:US
Mailing Address - Phone:619-402-0001
Mailing Address - Fax:619-402-0001
Practice Address - Street 1:250 BROADWAY
Practice Address - Street 2:TARGET 231
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92021
Practice Address - Country:US
Practice Address - Phone:619-402-0001
Practice Address - Fax:619-402-0001
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65366183500000X
HIPHY2997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist