Provider Demographics
NPI:1760533152
Name:EXPRESS VENTURE LLC
Entity type:Organization
Organization Name:EXPRESS VENTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-638-5059
Mailing Address - Street 1:100 CALLE ROMAN
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2929
Mailing Address - Country:US
Mailing Address - Phone:787-872-2630
Mailing Address - Fax:787-872-2630
Practice Address - Street 1:100 CALLE ROMAN
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2929
Practice Address - Country:US
Practice Address - Phone:787-872-2630
Practice Address - Fax:787-872-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07F1443OtherPHARMACY