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General NPI Number Information
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NPI Number | 1568724581
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH IVERSON RPH
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Gender | Male
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 11224 NE 124TH ST
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City | KIRKLAND
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State | WA
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Zip | 98034-4301
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Country | US
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Telephone | 425-820-0440
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Fax | 425-823-4940
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Provider Business Mailing Address
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Address Line | 11224 NE 124TH ST
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City | KIRKLAND
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State | WA
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Zip | 98034-4301
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Country | US
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Telephone | 425-820-0440
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Fax | 425-823-4940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH 00010122
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License Number State | WA
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