MEDICARE: BONNIE SUE DVORAK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	47549	TX

General Provider Information

NPI Number	:	1629677919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SUE DVORAK PHARMD

Provider Business Mailing Address
First Line	:	151 N FRIENDSWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3746
Country	:	US
Telephone Number	:	281-992-1510
Fax Number	:	281-992-6846

Provider Business Practice Location Address
First Line	:	151 N FRIENDSWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3746
Country	:	US
Telephone Number	:	281-992-1710
Fax Number	:	281-992-6846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	05/18/2026

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