Provider Demographics
NPI:1730334681
Name:DORA, DIANA ANTIONETTE (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ANTIONETTE
Last Name:DORA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EAST JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON,STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-425-8871
Mailing Address - Fax:
Practice Address - Street 1:2 EAST JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTNGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-425-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist