=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104263938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORES PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2013
-----------------------------------------------------
Last Update Date | 06/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1475 W OKEECHOBEE RD STE 5
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-2860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-0577
-----------------------------------------------------
Fax | 305-541-0580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1475 W OKEECHOBEE RD STE 5
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-2860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-0577
-----------------------------------------------------
Fax | 305-541-0580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY TECHNICIAN
-----------------------------------------------------
Name | ZULEMA FLORES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-541-0577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | PH26857
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------