Provider Demographics
NPI:1942759303
Name:DVORAK, JOSEPH RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
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 1:145 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3423
Mailing Address - Country:US
Mailing Address - Phone:920-926-4660
Mailing Address - Fax:
Practice Address - Street 1:145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3423
Practice Address - Country:US
Practice Address - Phone:920-926-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17786-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist