Provider Demographics
NPI:1992956999
Name:DVORAK, JOSEPH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DVORAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-6026
Mailing Address - Country:US
Mailing Address - Phone:320-322-5141
Mailing Address - Fax:320-322-5132
Practice Address - Street 1:1425 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-6026
Practice Address - Country:US
Practice Address - Phone:320-322-5141
Practice Address - Fax:320-322-5132
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist