Provider Demographics
NPI:1699069518
Name:SANTIAGO, IVONNE M (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. LAS CUMBRES
Mailing Address - Street 2:ESQ. JUAN C. BORBON
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-287-3725
Mailing Address - Fax:
Practice Address - Street 1:AVE. LAS CUMBRES
Practice Address - Street 2:ESQ. JUAN C. BORBON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-287-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist