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General NPI Number Information
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NPI Number | 1467519009
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Entity Type | Organization
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Legal Business Name | ER BLACK PHARMACY INC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 9553 MAIN STREET
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City | HOLLAND PATENT
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State | NY
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Zip | 13354-0205
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Country | US
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Telephone | 315-865-8141
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Fax | 315-865-4318
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Provider Business Mailing Address
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Address Line | 9553 MAIN ST
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City | HOLLAND PATENT
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State | NY
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Zip | 13354
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Country | US
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Telephone | 315-865-8141
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Fax | 315-865-4318
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Authorized Official
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Title or Position | PRESIDENT PHARMACIST
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Name | MR. EARL ROBERT BLACK JR.
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Credential | R PH
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Telephone | 315-865-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 024930
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License Number State | NY
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