Provider Demographics
NPI:1679111561
Name:FLOR, RICHARD JONATHAN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JONATHAN
Last Name:FLOR
Suffix:
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 1:915 W MORRISON AVE APT 89
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-6024
Mailing Address - Country:US
Mailing Address - Phone:310-349-7340
Mailing Address - Fax:
Practice Address - Street 1:1830 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-1449
Practice Address - Country:US
Practice Address - Phone:805-348-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist