Provider Demographics
NPI:1174548515
Name:IVERS, JOHN BOYCE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BOYCE
Last Name:IVERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LOUIS HENNA BLVD APT 622
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5743
Mailing Address - Country:US
Mailing Address - Phone:512-922-6022
Mailing Address - Fax:
Practice Address - Street 1:700 LOUIS HENNA BLVD APT 622
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5743
Practice Address - Country:US
Practice Address - Phone:512-382-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist