Healthcare Provider Details

I. General information

NPI: 1235111345
Provider Name (Legal Business Name): KEITH J ROMERO PHARMD PHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 ST MICHAELS DRIVE ST VINCENT HOSPITAL
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5287
  • Fax: 505-913-4949
Mailing address:
  • Phone: 505-913-5287
  • Fax: 505-913-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPC00000097
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPC97 PRH6595
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00006595
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC97
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: