Healthcare Provider Details

I. General information

NPI: 1578488862
Provider Name (Legal Business Name): EXPRESS VENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JIRETH #6, BO. BEJUCOS
ISABELA PR
00662-2929
US

IV. Provider business mailing address

CALLE JIRETH #6, BO. BEJUCOS
ISABELA PR
00662-2929
US

V. Phone/Fax

Practice location:
  • Phone: 787-638-5059
  • Fax:
Mailing address:
  • Phone: 787-638-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DEWIN ADRIEL ROMAN-LOPEZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 787-872-2630