Healthcare Provider Details

I. General information

NPI: 1457749855
Provider Name (Legal Business Name): RACHEL LYNN IVERSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL LYNN ALTHOFF PHARM.D.

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 E 55TH ST
TULSA OK
74146
US

IV. Provider business mailing address

12515 E 55TH ST
TULSA OK
74146-6233
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-2727
  • Fax:
Mailing address:
  • Phone: 918-493-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-14779
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15945
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: