Healthcare Provider Details

I. General information

NPI: 1700107737
Provider Name (Legal Business Name): IVAN VON MESSER PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 100TH STREET SW STE 100 RIGHT AID COMPANY
LAKEWOOD WA
98499
US

IV. Provider business mailing address

2802 N NARROWS DR UNIT C11
TACOMA WA
98407-1451
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3666
  • Fax:
Mailing address:
  • Phone: 253-495-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00070289
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: