Provider Demographics
NPI:1174077556
Name:SANTIAGO, SHAUNA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:SANTIAGO
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 1:4175 E LA PALMA AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1842
Mailing Address - Country:US
Mailing Address - Phone:714-279-6208
Mailing Address - Fax:714-279-4689
Practice Address - Street 1:4175 E LA PALMA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1842
Practice Address - Country:US
Practice Address - Phone:714-279-6208
Practice Address - Fax:714-279-4689
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist