Provider Demographics
NPI:1063410876
Name:ORAVECZ, DIANE KAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KAY
Last Name:ORAVECZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:200 E WILLOW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5441
Mailing Address - Country:US
Mailing Address - Phone:630-668-1180
Mailing Address - Fax:
Practice Address - Street 1:200 E WILLOW AVE STE 100
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5441
Practice Address - Country:US
Practice Address - Phone:630-668-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033124L183500000X
IL051.291636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist