Provider Demographics
NPI:1861423469
Name:ROMANO, MARCO (RPH)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:ROMANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SOMERVILLE AVE
Mailing Address - Street 2:TARGET PHARMACY 1441
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3405
Mailing Address - Country:US
Mailing Address - Phone:617-776-4919
Mailing Address - Fax:617-776-4919
Practice Address - Street 1:180 SOMERVILLE AVE
Practice Address - Street 2:TARGET PHARMACY 1441
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3405
Practice Address - Country:US
Practice Address - Phone:617-776-4919
Practice Address - Fax:617-776-4919
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0404586Medicaid