Provider Demographics
NPI:1588942817
Name:GARRISON, CLEVELAND MARTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:CLEVELAND
Middle Name:MARTIN
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 DALTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7614
Mailing Address - Country:US
Mailing Address - Phone:817-514-9470
Mailing Address - Fax:817-514-9467
Practice Address - Street 1:7151 BLVD 26
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8607
Practice Address - Country:US
Practice Address - Phone:817-514-9470
Practice Address - Fax:817-514-9467
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist