Provider Demographics
NPI:1467064675
Name:IVERS, TIMOTHY PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:IVERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LYNDALE AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3687
Mailing Address - Country:US
Mailing Address - Phone:612-872-7808
Mailing Address - Fax:612-874-1084
Practice Address - Street 1:3100 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2637
Practice Address - Country:US
Practice Address - Phone:602-812-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist