Provider Demographics
NPI:1467113555
Name:CLEVENGER, CHRISTOPHER CRAIG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CRAIG
Last Name:CLEVENGER
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 1:1660 SAINT LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4513
Mailing Address - Country:US
Mailing Address - Phone:478-960-7108
Mailing Address - Fax:
Practice Address - Street 1:1660 SAINT LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4513
Practice Address - Country:US
Practice Address - Phone:478-960-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist