MEDICARE: KEITH J ROMERO PHARMD PHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PC00000097	NM
2	1835N1003X	Nutrition Support Pharmacist	PC97 PRH6595	NM
3	1835P1200X	Pharmacotherapy Pharmacist	RP00006595	NM
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PC97	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PC97 RPH6595	OTHER	NM	PHARMD PHC

General Provider Information

NPI Number	:	1235111345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH J ROMERO PHARMD PHC

Provider Business Mailing Address
First Line	:	455 ST MICHAELS DRIVE
Second Line	:	ST VINCENT HOSPITAL
City	:	SANTA FE
State	:	NM
Zip	:	87505
Country	:	US
Telephone Number	:	505-913-5287
Fax Number	:	505-913-4949

Provider Business Practice Location Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-913-5287
Fax Number	:	505-913-4949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	05/21/2014

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Directions to “ KEITH J ROMERO PHARMD PHC” Practice Location

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