Healthcare Provider Details

I. General information

NPI: 1699649574
Provider Name (Legal Business Name): ROMAN ROMERO DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 GOLF COURSE RD NW
ALBUQUERQUE NM
87120-5801
US

IV. Provider business mailing address

4348 CANADA PL NW
ALBUQUERQUE NM
87114-5637
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-1321
  • Fax:
Mailing address:
  • Phone: 505-897-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010238
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: