Provider Demographics
NPI:1457749855
Name:IVERSON, RACHEL LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:IVERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:ALTHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12515 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6233
Mailing Address - Country:US
Mailing Address - Phone:918-493-2727
Mailing Address - Fax:
Practice Address - Street 1:12515 E 55TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146
Practice Address - Country:US
Practice Address - Phone:918-493-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14779183500000X
OK15945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist