Provider Demographics
NPI:1619016680
Name:FLORES, EDWARD S (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
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 1:4108 73RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3945
Mailing Address - Country:US
Mailing Address - Phone:646-573-6074
Mailing Address - Fax:
Practice Address - Street 1:4108 73RD ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3945
Practice Address - Country:US
Practice Address - Phone:646-573-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist