Provider Demographics
NPI:1164501839
Name:MARILIA PAGAN SANTIAGO
Entity type:Organization
Organization Name:MARILIA PAGAN SANTIAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-891-4723
Mailing Address - Street 1:CARR 459 BDA CABAN 160 A
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-891-4723
Mailing Address - Fax:787-891-4723
Practice Address - Street 1:CARR 459 BDA CABAN 160 A
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-4723
Practice Address - Fax:787-891-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR20-F-23603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086280OtherPK