Provider Demographics
NPI:1568266229
Name:EXPRESS VENTURE LLC
Entity type:Organization
Organization Name:EXPRESS VENTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMAN LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-638-5059
Mailing Address - Street 1:100 CALLE ROMAN
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2929
Mailing Address - Country:US
Mailing Address - Phone:787-872-2630
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE ROMAN
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2929
Practice Address - Country:US
Practice Address - Phone:787-872-2630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy