Provider Demographics
NPI:1891806105
Name:CLEVELAND, JOHNNY HOYT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:HOYT
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:LOCUST FORK
Mailing Address - State:AL
Mailing Address - Zip Code:35097-0052
Mailing Address - Country:US
Mailing Address - Phone:205-680-2222
Mailing Address - Fax:205-680-2200
Practice Address - Street 1:29984 STATE HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:LOCUST FORK
Practice Address - State:AL
Practice Address - Zip Code:35097-5878
Practice Address - Country:US
Practice Address - Phone:205-680-2222
Practice Address - Fax:205-680-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist