Provider Demographics
NPI:1447879408
Name:CLEVENGER, DENISE MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 THORNAPPLE GRV
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8608
Mailing Address - Country:US
Mailing Address - Phone:614-309-0659
Mailing Address - Fax:
Practice Address - Street 1:1840 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9600
Practice Address - Country:US
Practice Address - Phone:937-653-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist