Individual
LISA K IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30833 N STAR DR STE 2, BREEZY POINT, MN 56472-4407
(218) 562-4000
Mailing address
5060 LOWER ROY LAKE RD, NISSWA, MN 56468-2736
(121) 883-8869
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
115441
MN
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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