Provider Demographics
NPI:1669768883
Name:ROMAN, LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 MONTGOMERY RD
Mailing Address - Street 2:T-1042
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6068
Mailing Address - Country:US
Mailing Address - Phone:410-203-1171
Mailing Address - Fax:410-203-1171
Practice Address - Street 1:4390 MONTGOMERY RD
Practice Address - Street 2:T-1042
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6068
Practice Address - Country:US
Practice Address - Phone:410-203-1171
Practice Address - Fax:410-203-1171
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist