Healthcare Provider Details

I. General information

NPI: 1366898827
Provider Name (Legal Business Name): EVA FLYNN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 DANNI CT
NIPOMO CA
93444-6675
US

IV. Provider business mailing address

1098 DANNI CT
NIPOMO CA
93444-6675
US

V. Phone/Fax

Practice location:
  • Phone: 661-747-7656
  • Fax:
Mailing address:
  • Phone: 661-747-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33377
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier33377
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBOARD OF PHARMACY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: