Healthcare Provider Details

I. General information

NPI: 1962794958
Provider Name (Legal Business Name): DIANE FISCHER GBUREK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GRANT HILL LN
WINSTON SALEM NC
27104-5064
US

IV. Provider business mailing address

1221 BARKSDALE RD
LEWISVILLE NC
27023-8619
US

V. Phone/Fax

Practice location:
  • Phone: 336-245-0471
  • Fax:
Mailing address:
  • Phone: 336-766-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08346
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: