Healthcare Provider Details

I. General information

NPI: 1629341383
Provider Name (Legal Business Name): PHILLIP M ROMERO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N CIRCLE DR
COLORADO SPRINGS CO
80909-5038
US

IV. Provider business mailing address

920 N CIRCLE DR
COLORADO SPRINGS CO
80909-5038
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-9090
  • Fax: 719-473-9342
Mailing address:
  • Phone: 719-473-9090
  • Fax: 719-473-9342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16813
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: