Provider Demographics
NPI:1154829190
Name:DU PREEZ, IVAN DEREK (RPH)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:DEREK
Last Name:DU PREEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46422 BRADSHAW TRL
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2353
Mailing Address - Country:US
Mailing Address - Phone:760-699-3726
Mailing Address - Fax:
Practice Address - Street 1:5601 E RAMON RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-3605
Practice Address - Country:US
Practice Address - Phone:760-322-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist