Provider Demographics
NPI:1740491604
Name:ROMAN, LILLIAM
Entity type:Individual
Prefix:
First Name:LILLIAM
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1648
Mailing Address - Country:US
Mailing Address - Phone:787-820-5247
Mailing Address - Fax:
Practice Address - Street 1:AVE. MIRAMAR
Practice Address - Street 2:CARR. #2 KM 78.7
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614
Practice Address - Country:US
Practice Address - Phone:787-878-5757
Practice Address - Fax:787-817-3757
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist