MEDICARE: JOSEPH J ROMAN RPH

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	PS15220	FL

General Provider Information

NPI Number	:	1952577785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J ROMAN RPH

Provider Business Mailing Address
First Line	:	7710 261ST ST E
Second Line	:
City	:	MYAKKA CITY
State	:	FL
Zip	:	34251-5184
Country	:	US
Telephone Number	:	941-322-1966
Fax Number	:	941-727-8195

Provider Business Practice Location Address
First Line	:	7290 55 AVE E
Second Line	:	PUBLIX PHARMACY #491
City	:	BRADENTON
State	:	FL
Zip	:	34203-8002
Country	:	US
Telephone Number	:	941-727-8412
Fax Number	:	941-727-8195

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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