Provider Demographics
NPI:1770090573
Name:FLORES, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
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 1:965 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-1442
Mailing Address - Country:US
Mailing Address - Phone:740-753-1984
Mailing Address - Fax:740-753-3188
Practice Address - Street 1:965 POPLAR ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1442
Practice Address - Country:US
Practice Address - Phone:740-753-1984
Practice Address - Fax:740-753-3188
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03119127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist