Provider Demographics
NPI:1093425712
Name:FLORES, JAQUELYNN ANN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:JAQUELYNN
Middle Name:ANN
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12037 ZIA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1435
Mailing Address - Country:US
Mailing Address - Phone:575-639-1768
Mailing Address - Fax:
Practice Address - Street 1:13000 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4803
Practice Address - Country:US
Practice Address - Phone:505-298-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00000126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist