Provider Demographics
NPI:1558331199
Name:CLEVELAND, CLIFTON (RPH)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 E HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6134
Mailing Address - Country:US
Mailing Address - Phone:812-882-6193
Mailing Address - Fax:812-882-6186
Practice Address - Street 1:402 S 6TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1023
Practice Address - Country:US
Practice Address - Phone:812-882-6193
Practice Address - Fax:812-882-6186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013527A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist