Healthcare Provider Details

I. General information

NPI: 1447805056
Provider Name (Legal Business Name): MARK ISAAC BLACK PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GRACE ST.
PITTSBURGH PA
15211-1503
US

IV. Provider business mailing address

201 GRACE ST.
PITTSBURGH PA
15211
US

V. Phone/Fax

Practice location:
  • Phone: 412-381-1464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453717
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: