MEDICARE: JOEL FLORES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	72895	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72895	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1285978650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL FLORES

Provider Business Mailing Address
First Line	:	18568 VENTURA BLVD
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18568 VENTURA BLVD
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4146
Country	:	US
Telephone Number	:	818-776-1363
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED PHARMACY TECHNICIAN
Name	:	JOEL FLORES
Credential	:
Telephone Number	:	818-776-1363

Provider Enumeration Date	:	11/24/2012
Last Update Date	:	11/24/2012

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Directions to “JOEL FLORES ” Practice Location

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