Healthcare Provider Details

I. General information

NPI: 1093930760
Provider Name (Legal Business Name): KENNETH ROMP PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RODEO RD STE A1
SANTA FE NM
87507-6503
US

IV. Provider business mailing address

PO BOX 1545
MORIARTY NM
87035-1545
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-6177
  • Fax: 505-471-3822
Mailing address:
  • Phone: 505-384-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006622
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: