Provider Demographics
NPI:1912340951
Name:IVERSON, JOANNE SORENSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:SORENSON
Last Name:IVERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 41ST ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1740
Mailing Address - Country:US
Mailing Address - Phone:253-848-7440
Mailing Address - Fax:
Practice Address - Street 1:3007 41ST ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1740
Practice Address - Country:US
Practice Address - Phone:253-848-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist