Provider Demographics
NPI:1962484550
Name:IVERSON, PAUL SCOTT (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:SCOTT
Last Name:IVERSON
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MINNESOTA AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3127
Mailing Address - Country:US
Mailing Address - Phone:218-444-3000
Mailing Address - Fax:218-444-6640
Practice Address - Street 1:408 MINNESOTA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3127
Practice Address - Country:US
Practice Address - Phone:218-444-3000
Practice Address - Fax:218-444-6640
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1137215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist