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General NPI Number Information
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NPI Number | 1336559202
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Entity Type | Individual
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Provider Name | MARTHA BLACK PHARM D
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Gender | Female
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 36865 26 MILE RD
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City | LENOX
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State | MI
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Zip | 48048-3163
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Country | US
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Telephone | 586-716-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 72901 SORREL DR
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City | BRUCE TWP
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State | MI
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Zip | 48065-3934
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Country | US
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Telephone | 586-292-7954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5302034191
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License Number State | MI
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