Provider Demographics
NPI:1962170431
Name:IVERY, JACQUELYNE (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYNE
Middle Name:
Last Name:IVERY
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N MOORE ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1947
Mailing Address - Country:US
Mailing Address - Phone:301-233-6941
Mailing Address - Fax:
Practice Address - Street 1:752 GLENEAGLES DR
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-7011
Practice Address - Country:US
Practice Address - Phone:301-233-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020090861835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care