Provider Demographics
NPI:1861260945
Name:ROA, JHONNATAN J (PHARMD)
Entity type:Individual
Prefix:
First Name:JHONNATAN
Middle Name:J
Last Name:ROA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. COUNTRY STATES
Mailing Address - Street 2:CALLE 2 #B25
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-359-3207
Mailing Address - Fax:
Practice Address - Street 1:350 CARR. 167 INTER. 830 CANA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-279-8202
Practice Address - Fax:787-279-8135
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist