Provider Demographics
NPI:1760285332
Name:ROMAN, ALEXIS JADRIEL SR
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JADRIEL
Last Name:ROMAN
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:JADRIEL
Other - Last Name:ROMAN
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:URB FLORAL PARK
Mailing Address - Street 2:CALLE SALVADOR BRAU 404
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3519
Mailing Address - Country:US
Mailing Address - Phone:787-478-1423
Mailing Address - Fax:787-478-1423
Practice Address - Street 1:URB FLORAL PARK
Practice Address - Street 2:CALLE SALVADOR BRAU 404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3519
Practice Address - Country:US
Practice Address - Phone:787-478-1423
Practice Address - Fax:787-478-1423
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16148183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician