Active NPI
Marissa Lee Iverson, PHARMD
- Pharmacist
- North Hollywood, CA
National Provider Identifier
1750873022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 6469
- Practice address
- 10945 Victory Blvd
North Hollywood, CA 91606-3717 - Phone
- (818) 487-0119
- NPI assigned
- Jun 3, 2018
- Last updated
- Jan 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 125989 | MN | |
| Pharmacist | 183500000X | 6469 | ND | Primary |
| Pharmacist | 183500000X | 77730 | CA |
Addresses
Primary practice location
10945 Victory Blvd
North Hollywood, CA 91606-3717
Mailing address
619 Dakota Ave
Wahpeton, ND 58075-4325
Phone (310) 625-3686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77730 | CA | MD | Marriage & Family Therapist |
| 6469 | ND | MD | Pharmacist |
| 125989 | MN | MD | Pharmacy |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS, L.L.C. | Pharmacy | Past | Accepting new patients |
| Garfield Beach CVS LLC | Pharmacy | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736812800000",
"number": "1750873022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 DAKOTA AVE",
"city": "WAHPETON",
"state": "ND",
"postal_code": "580754325",
"telephone_number": "310-625-3686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10945 VICTORY BLVD",
"city": "NORTH HOLLYWOOD",
"state": "CA",
"postal_code": "916063717",
"telephone_number": "818-487-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVERSON",
"first_name": "MARISSA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-03",
"last_updated": "2025-01-14",
"certification_date": "2025-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MN",
"license": "125989",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "6469",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "77730",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.