Provider Demographics
NPI:1629677919
Name:DVORAK, BONNIE SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:DVORAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:ANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 W LEAGUE CITY PKWY
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7079
Mailing Address - Country:US
Mailing Address - Phone:281-672-6086
Mailing Address - Fax:281-672-6089
Practice Address - Street 1:1920 W LEAGUE CITY PKWY
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7079
Practice Address - Country:US
Practice Address - Phone:281-672-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX475491835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist