Provider Demographics
NPI:1073024220
Name:FLORES, SHAUN (RPH)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 CASTLEROCK LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1697
Mailing Address - Country:US
Mailing Address - Phone:209-406-4678
Mailing Address - Fax:
Practice Address - Street 1:733 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4507
Practice Address - Country:US
Practice Address - Phone:805-922-2040
Practice Address - Fax:805-349-0048
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist