Provider Demographics
NPI:1962794958
Name:GBUREK, DIANE FISCHER (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:FISCHER
Last Name:GBUREK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BARKSDALE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8619
Mailing Address - Country:US
Mailing Address - Phone:336-766-8591
Mailing Address - Fax:
Practice Address - Street 1:150 GRANT HILL LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-5064
Practice Address - Country:US
Practice Address - Phone:336-245-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist