Provider Demographics
NPI:1679891519
Name:IVERSON, DAVID FLINT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FLINT
Last Name:IVERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 N HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5160
Mailing Address - Country:US
Mailing Address - Phone:208-851-0957
Mailing Address - Fax:
Practice Address - Street 1:12746 N HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-5160
Practice Address - Country:US
Practice Address - Phone:208-851-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDE13394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist