Provider Demographics
NPI:1710783691
Name:SANTIAGO PONCE, ISMAEL (LCDO)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:SANTIAGO PONCE
Suffix:
Gender:
Credentials:LCDO
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 312
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-0312
Mailing Address - Country:US
Mailing Address - Phone:787-822-2425
Mailing Address - Fax:787-822-3605
Practice Address - Street 1:13 CALLE ANTONIO ALCAZAR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-1913
Practice Address - Country:US
Practice Address - Phone:787-249-0953
Practice Address - Fax:787-822-3605
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist