Healthcare Provider Details

I. General information

NPI: 1114239688
Provider Name (Legal Business Name): CHRISTOPHER DANIEL IVIE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

3913 BLANCHE ST
PASADENA CA
91107-3947
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-4711
  • Fax:
Mailing address:
  • Phone: 626-372-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: