Provider Demographics
NPI:1710287883
Name:CLEVELAND, CRYSTAL DANIELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:DANIELLE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 L ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2545
Mailing Address - Country:US
Mailing Address - Phone:202-719-2439
Mailing Address - Fax:202-719-2440
Practice Address - Street 1:490 L ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2545
Practice Address - Country:US
Practice Address - Phone:202-719-2439
Practice Address - Fax:202-719-2440
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist