Provider Demographics
NPI:1144508219
Name:SANTIAGO, GLORYMAR (RPH, PHARM D)
Entity type:Individual
Prefix:
First Name:GLORYMAR
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:RPH, 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:PO BOX 6010
Mailing Address - Street 2:STATION 1
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5010
Mailing Address - Country:US
Mailing Address - Phone:787-246-6501
Mailing Address - Fax:787-740-0800
Practice Address - Street 1:HC 69 BOX 15544
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9872
Practice Address - Country:US
Practice Address - Phone:787-780-7383
Practice Address - Fax:787-780-7389
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS5010611835P0018X
PR49561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist