Healthcare Provider Details

I. General information

NPI: 1629984356
Provider Name (Legal Business Name): MRS. CAROL ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 NW 53RD TER STE 512D
DORAL FL
33166-4851
US

IV. Provider business mailing address

16721 NW 80TH CT
MIAMI LAKES FL
33016-3408
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-1578
  • Fax:
Mailing address:
  • Phone: 305-689-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: