Provider Demographics
NPI:1073971115
Name:ROMAN, YOUSSEF (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:M
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1998 BREWSTER ST APT 110
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8170 33RD AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-4516
Practice Address - Country:US
Practice Address - Phone:952-883-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist