Provider Demographics
NPI:1639772213
Name:ROMAN, MERCY ANN BANZON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MERCY ANN
Middle Name:BANZON
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5715
Mailing Address - Country:US
Mailing Address - Phone:702-452-2937
Mailing Address - Fax:702-459-4726
Practice Address - Street 1:4391 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5715
Practice Address - Country:US
Practice Address - Phone:702-452-2937
Practice Address - Fax:702-459-4726
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4358183500000X
IL051302956183500000X
NV19653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist