Provider Demographics
NPI:1598057184
Name:ROMAN, KIMBERLY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1411
Mailing Address - Country:US
Mailing Address - Phone:304-845-4230
Mailing Address - Fax:304-845-7228
Practice Address - Street 1:120 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1411
Practice Address - Country:US
Practice Address - Phone:304-845-4230
Practice Address - Fax:304-845-7228
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist