Healthcare Provider Details

I. General information

NPI: 1063410876
Provider Name (Legal Business Name): DIANE KAY ORAVECZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE KAY RYAN RPH

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WILLOW AVE STE 100
WHEATON IL
60187-5441
US

IV. Provider business mailing address

200 E WILLOW AVE STE 100
WHEATON IL
60187-5441
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-1180
  • Fax:
Mailing address:
  • Phone: 630-668-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033124L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.291636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: