Provider Demographics
NPI:1154084606
Name:CLEAVER, EVAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N CENTRAL AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2048
Mailing Address - Country:US
Mailing Address - Phone:432-770-3523
Mailing Address - Fax:
Practice Address - Street 1:2909 TAYLOR ST STE C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1909
Practice Address - Country:US
Practice Address - Phone:432-770-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist