Provider Demographics
NPI:1639729775
Name:JANI, ROMAN B (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:B
Last Name:JANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TRUMBULL ST APT 903
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1517
Mailing Address - Country:US
Mailing Address - Phone:412-818-7575
Mailing Address - Fax:
Practice Address - Street 1:649 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1082
Practice Address - Country:US
Practice Address - Phone:203-757-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist