Provider Demographics
NPI:1093930760
Name:ROMP, KENNETH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:ROMP
Suffix:
Gender:M
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:PO BOX 1545
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-1545
Mailing Address - Country:US
Mailing Address - Phone:505-384-2894
Mailing Address - Fax:
Practice Address - Street 1:2801 RODEO RD STE A1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-471-6177
Practice Address - Fax:505-471-3822
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist