Healthcare Provider Details

I. General information

NPI: 1356658983
Provider Name (Legal Business Name): DAIVD C FLORES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N MAIN ST
LAS CRUCES NM
88001-1162
US

IV. Provider business mailing address

3100 N MAIN ST
LAS CRUCES NM
88001-1162
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-0298
  • Fax: 575-525-0166
Mailing address:
  • Phone: 575-525-0298
  • Fax: 575-525-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4438
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: