Provider Demographics
NPI:1700107737
Name:VON MESSER, IVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:VON MESSER
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 1:2802 N NARROWS DR UNIT C11
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1451
Mailing Address - Country:US
Mailing Address - Phone:253-495-7543
Mailing Address - Fax:
Practice Address - Street 1:5700 100TH STREET SW STE 100
Practice Address - Street 2:RIGHT AID COMPANY
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist