Provider Demographics
NPI:1568724581
Name:IVERSON, ROBERT JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:IVERSON
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 1:11224 NE 124TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4301
Mailing Address - Country:US
Mailing Address - Phone:425-820-0440
Mailing Address - Fax:425-823-4940
Practice Address - Street 1:11224 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4301
Practice Address - Country:US
Practice Address - Phone:425-820-0440
Practice Address - Fax:425-823-4940
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00010122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist