Provider Demographics
NPI:1235111345
Name:ROMERO, KEITH J (PHARMD PHC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PHARMD PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ST MICHAELS DRIVE
Mailing Address - Street 2:ST VINCENT HOSPITAL
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-913-5287
Mailing Address - Fax:505-913-4949
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-913-5287
Practice Address - Fax:505-913-4949
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC00000097183500000X
NMPC97 PRH65951835N1003X
NMRP000065951835P1200X
NMPC971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPC97 RPH6595OtherPHARMD PHC