=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083731921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMIRO ROMAN JR. PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2007
-----------------------------------------------------
Last Update Date | 03/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 E OSCEOLA PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34743-8602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-348-2323
-----------------------------------------------------
Fax | 407-348-8799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 E OSCEOLA PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34743-8602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-348-2323
-----------------------------------------------------
Fax | 407-348-8799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 002169
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | PS43168
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------