Provider Demographics
NPI:1083941942
Name:ESPENILLA, ROMMEL TAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROMMEL
Middle Name:TAN
Last Name:ESPENILLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7359
Mailing Address - Country:US
Mailing Address - Phone:409-755-2858
Mailing Address - Fax:
Practice Address - Street 1:902 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7359
Practice Address - Country:US
Practice Address - Phone:409-755-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist