Provider Demographics
NPI:1609232859
Name:ROMAINE, IFEOMA FELICIA
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:FELICIA
Last Name:ROMAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IFY
Other - Middle Name:
Other - Last Name:ROMAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D, BS, BA, AS
Mailing Address - Street 1:8102 ROBIN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6026
Mailing Address - Country:US
Mailing Address - Phone:505-554-9771
Mailing Address - Fax:
Practice Address - Street 1:400 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2758
Practice Address - Country:US
Practice Address - Phone:505-292-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist