Provider Demographics
NPI:1699487934
Name:SANTIAGO RIVERA, ISMARIE
Entity type:Individual
Prefix:
First Name:ISMARIE
Middle Name:
Last Name:SANTIAGO RIVERA
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:URB. SAN CRISTOBAL
Mailing Address - Street 2:15 FELIX MORALES LOPEZ
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-901-0405
Mailing Address - Fax:
Practice Address - Street 1:URB. SAN CRISTOBAL
Practice Address - Street 2:15 FELIX MORALES LOPEZ
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-901-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist