Active NPI
Edith A Dvorak, PHARMD, R.PH.
- Pharmacist
- Pocatello, ID
National Provider Identifier
1326101015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P4603
- Practice address
- 435 E Bonneville
Pocatello, ID 83201 - Phone
- (208) 233-3466
- NPI assigned
- Dec 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P4603 | ID | Primary |
Addresses
Primary practice location
435 E Bonneville
Pocatello, ID 83201
Mailing address
408 Polk Street
American Falls, ID 83211
Phone (208) 251-1665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P4603 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326101015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 POLK STREET",
"city": "AMERICAN FALLS",
"state": "ID",
"postal_code": "83211",
"telephone_number": "208-251-1665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 E BONNEVILLE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "83201",
"telephone_number": "208-233-3466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DVORAK",
"first_name": "EDITH",
"middle_name": "A",
"credential": "PHARMD, R.PH.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P4603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.