Provider Demographics
NPI:1184779290
Name:ROMER, JOHN JAMES
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAMES
Last Name:ROMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-6163
Mailing Address - Country:US
Mailing Address - Phone:828-696-9469
Mailing Address - Fax:
Practice Address - Street 1:605 5TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4205
Practice Address - Country:US
Practice Address - Phone:828-692-4266
Practice Address - Fax:828-692-7808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3421663OtherNABP