Healthcare Provider Details

I. General information

NPI: 1265370944
Provider Name (Legal Business Name): EMMA IVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

1533 ELLIS RD APT C305
DURHAM NC
27703-6374
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3710
  • Fax:
Mailing address:
  • Phone: 847-643-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: