Provider Demographics
NPI:1790366805
Name:ROMAN, ELIEZER LOPEZ
Entity type:Individual
Prefix:
First Name:ELIEZER
Middle Name:LOPEZ
Last Name:ROMAN
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:BO PADILLA CARR 159
Mailing Address - Street 2:BARRIO PADILLA
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-376-9263
Mailing Address - Fax:
Practice Address - Street 1:BO PADILLA CARR 159
Practice Address - Street 2:BARRIO PADILLA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-376-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014654183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR014654OtherPHARMACY TECNICIAN