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NPI Code Detail

MEDICARE: DR. TIMOTHY PATRICK IVERS PHARMD

MEDICARE: DR. TIMOTHY PATRICK IVERS 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
1183500000XPharmacist123482MN

General Provider Information

NPI Number : 1467064675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY PATRICK IVERS PHARMD
Provider Business Mailing Address
First Line : 2100 LYNDALE AVE S STE A
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-3687
Country : US
Telephone Number : 612-872-7808
Fax Number : 612-874-1084
Provider Business Practice Location Address
First Line : 3100 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2637
Country : US
Telephone Number : 602-812-4581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2020
Last Update Date : 12/03/2021

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