Provider Demographics
NPI:1306187224
Name:DVORAK, MELISSA KAY (CPHT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:DVORAK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-2542
Mailing Address - Country:US
Mailing Address - Phone:918-762-3666
Mailing Address - Fax:918-762-2288
Practice Address - Street 1:539 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2542
Practice Address - Country:US
Practice Address - Phone:918-762-3666
Practice Address - Fax:918-762-2288
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK580107010269312183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician