Healthcare Provider Details

I. General information

NPI: 1073836920
Provider Name (Legal Business Name): ROMAN FLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 BROADWAY APT H17
MENANDS NY
12204-2897
US

IV. Provider business mailing address

587 BROADWAY APT H17
MENANDS NY
12204-2897
US

V. Phone/Fax

Practice location:
  • Phone: 518-727-8270
  • Fax:
Mailing address:
  • Phone: 518-727-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: