Provider Demographics
NPI:1083827604
Name:CLEAVER, DAVID GEORGE (BS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36039 VIA GRAN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9625
Mailing Address - Country:US
Mailing Address - Phone:352-589-2695
Mailing Address - Fax:
Practice Address - Street 1:2500 CITRUS BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7203
Practice Address - Country:US
Practice Address - Phone:352-728-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist