Provider Demographics
NPI:1790900322
Name:ROMAN, ELYNETTE (PT)
Entity Type:Individual
Prefix:MISS
First Name:ELYNETTE
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CALLE RIO GRANDE
Mailing Address - Street 2:MONTE CASINO HEIGHTS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3744
Mailing Address - Country:US
Mailing Address - Phone:787-251-3221
Mailing Address - Fax:
Practice Address - Street 1:67 CALLE RIO GRANDE
Practice Address - Street 2:MONTE CASINO HEIGHTS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3744
Practice Address - Country:US
Practice Address - Phone:787-251-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician