Provider Demographics
NPI:1891988457
Name:ROMAN, MARILIS ARLENE I (LIC)
Entity Type:Individual
Prefix:MRS
First Name:MARILIS
Middle Name:ARLENE
Last Name:ROMAN
Suffix:I
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB JARDINES DE BORINQUEN CALLE 1 D 14
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-877-2121
Mailing Address - Fax:787-877-2145
Practice Address - Street 1:URB JARDINES DE BORINQUEN CALLE 1 D 14
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-877-2121
Practice Address - Fax:787-877-2145
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist