MEDICARE: AMY IVERSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60298124	WA

General Provider Information

NPI Number	:	1326455460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY IVERSON PHARMD

Provider Business Mailing Address
First Line	:	540 7TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-1605
Country	:	US
Telephone Number	:	360-414-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 7TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-1605
Country	:	US
Telephone Number	:	360-414-9602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2022

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Directions to “ AMY IVERSON PHARMD” Practice Location

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