Provider Demographics
NPI:1720713712
Name:LUO, ROMAN MA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:MA
Last Name:LUO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8348 SCOTLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3186
Mailing Address - Country:US
Mailing Address - Phone:703-595-1065
Mailing Address - Fax:703-595-1065
Practice Address - Street 1:7910 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-7826
Practice Address - Country:US
Practice Address - Phone:703-799-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist