Individual
MR. TOM DALE IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1415 EGLIN ST., RAPID CITY, SD 57703
(605) 341-8621
(605) 341-8631
Mailing address
1415 EGLIN ST., RAPID CITY, SD 57703
(605) 341-8621
(605) 341-8631
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4048
SD
Other
Enumeration date
06/15/2011
Last updated
06/15/2011
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