Healthcare Provider Details

I. General information

NPI: 1760533152
Provider Name (Legal Business Name): EXPRESS VENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALLE ROMAN
ISABELA PR
00662-2929
US

IV. Provider business mailing address

100 CALLE ROMAN
ISABELA PR
00662-2929
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-2630
  • Fax: 787-872-2630
Mailing address:
  • Phone: 787-872-2630
  • Fax: 787-872-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier07F1443
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHARMACY

VIII. Authorized Official

Name: DEWIN ROMAN-LOPEZ
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 787-638-5059