Provider Demographics
NPI:1225365109
Name:PROCIDA, ROMANO (RPH)
Entity Type:Individual
Prefix:
First Name:ROMANO
Middle Name:
Last Name:PROCIDA
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 1:740 QUINTANA RD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442
Mailing Address - Country:US
Mailing Address - Phone:205-772-6198
Mailing Address - Fax:205-772-8081
Practice Address - Street 1:740 QUINTANA RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442
Practice Address - Country:US
Practice Address - Phone:205-772-6198
Practice Address - Fax:205-772-8081
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist