Individual provider Active NPI

John J Roman

  • Pharmacist
  • Wilkes Barre, PA
National Provider Identifier
1396844890
Registry record updated Jan 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PP415427L Issued in PA
Practice address
15 Public SQ Ste 210
Wilkes Barre, PA 18701-1703
Phone
(570) 823-0101
NPI assigned
Sep 21, 2006
Last updated
Jan 19, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PP415427L PA Primary

Addresses

Primary practice location

15 Public SQ Ste 210
Wilkes Barre, PA 18701-1703

Mailing address

15 Public SQ Ste 210
Wilkes Barre, PA 18701-1703

Other identifiers 1

IdentifierTypeStateIssuer
PP415427LOtherPASTATE LIC #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PP415427LPAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1396844890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ STE 210",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ STE 210",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011703",
            "telephone_number": "570-823-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "JOHN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "PP415427L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC #",
            "identifier": "PP415427L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.