Provider Demographics
NPI:1790940690
Name:DORWART, DAVID J (RPH, PD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DORWART
Suffix:
Gender:M
Credentials:RPH, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10199 POINTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6300
Mailing Address - Country:US
Mailing Address - Phone:407-354-1243
Mailing Address - Fax:
Practice Address - Street 1:29 BLAKE BLVD
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5414
Practice Address - Country:US
Practice Address - Phone:321-939-3106
Practice Address - Fax:863-421-0578
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29425183500000X
PAPS0029425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist