Provider Demographics
NPI:1871194522
Name:ROMAN, AMIE E (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:E
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 TEDS WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7218
Mailing Address - Country:US
Mailing Address - Phone:814-327-5824
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5204
Practice Address - Country:US
Practice Address - Phone:814-940-2554
Practice Address - Fax:814-940-2565
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044099L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist