Provider Demographics
NPI:1679044481
Name:SANTIAGO-RIVERA, KATHY A (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:SANTIAGO-RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CALLE CORAL
Mailing Address - Street 2:LAGO PLAYA APT 3021
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-424-5886
Mailing Address - Fax:
Practice Address - Street 1:CENTRO GRAN CARIBE 104 CALLE 678 #99
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-883-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist