Provider Demographics
NPI:1386969772
Name:DVORAK, DIANA (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DVORAK
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W ENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3806
Mailing Address - Country:US
Mailing Address - Phone:972-875-5996
Mailing Address - Fax:972-875-2969
Practice Address - Street 1:718 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4534
Practice Address - Country:US
Practice Address - Phone:972-875-6798
Practice Address - Fax:972-875-2514
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293275183500000X
TX40003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist