Individual
EDITH A DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD, R.PH.
Contact information
Practice address
435 E BONNEVILLE, POCATELLO, ID 83201
(208) 233-3466
Mailing address
408 POLK STREET, AMERICAN FALLS, ID 83211
(208) 251-1665
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4603
ID
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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