Provider Demographics
NPI:1831476332
Name:ROMO, BRYAN (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ROMO
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 1:2805 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4073
Mailing Address - Country:US
Mailing Address - Phone:305-292-9833
Mailing Address - Fax:305-292-3034
Practice Address - Street 1:2805 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4073
Practice Address - Country:US
Practice Address - Phone:305-292-9833
Practice Address - Fax:305-292-3034
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist