MEDICARE: DR. JACQUELYNE IVERY RPH, 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	1835P2201X	Ambulatory Care Pharmacist	0202009086	VA

General Provider Information

NPI Number	:	1962170431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELYNE IVERY RPH, PHARMD

Provider Business Mailing Address
First Line	:	1700 N MOORE ST STE 2350
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1947
Country	:	US
Telephone Number	:	301-233-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 GLENEAGLES DR
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-7011
Country	:	US
Telephone Number	:	301-233-6941
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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