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General NPI Number Information
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NPI Number | 1306501382
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Entity Type | Individual
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Provider Name | KELVIN D CRUZ ROMAN
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Gender | Male
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 3480 AVE MILITAR
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City | ISABELA
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State | PR
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Zip | 00662-4065
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Country | US
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Telephone | 787-872-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 212 CALLE COQUI
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City | ISABELA
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State | PR
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Zip | 00662-2138
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Country | US
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Telephone | 787-310-3956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7071
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License Number State | PR
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