Provider Demographics
NPI:1912042052
Name:ROMAN, AMNERIS
Entity Type:Individual
Prefix:
First Name:AMNERIS
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E6 CALLE 1
Mailing Address - Street 2:URB. LOMA ALTA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-6927
Mailing Address - Country:US
Mailing Address - Phone:787-762-5805
Mailing Address - Fax:787-752-0140
Practice Address - Street 1:CALLE 1 AVENIDA A CENTRO COMERCIAL METROPOLIS
Practice Address - Street 2:SUPER FARMACIA METROPOLIS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-762-5805
Practice Address - Fax:787-752-0140
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5325183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician