Provider Demographics
NPI:1467767624
Name:FLORES, JAVIER LUIS JR
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:LUIS
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 LAMB RD
Mailing Address - Street 2:APT #308
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-5227
Mailing Address - Country:US
Mailing Address - Phone:956-285-4643
Mailing Address - Fax:
Practice Address - Street 1:14505 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1629
Practice Address - Country:US
Practice Address - Phone:210-408-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist