Provider Demographics
NPI:1700985843
Name:DVORKIN, IRWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:
Last Name:DVORKIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 HOLMBERG RD
Mailing Address - Street 2:APT. #2813
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4536
Mailing Address - Country:US
Mailing Address - Phone:954-753-6074
Mailing Address - Fax:954-974-2852
Practice Address - Street 1:277 S POMPANO PKWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3005
Practice Address - Country:US
Practice Address - Phone:954-974-4658
Practice Address - Fax:954-974-2852
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050980Medicare ID - Type Unspecified