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General NPI Number Information
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NPI Number | 1790729077
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Entity Type | Organization
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Legal Business Name | J & I BLACK, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 113 E CENTRAL AVE
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City | SUTHERLIN
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State | OR
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Zip | 97479-9556
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Country | US
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Telephone | 541-459-2712
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Fax | 541-459-9129
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | SUTHERLIN
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State | OR
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Zip | 97479-0309
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Country | US
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Telephone | 541-459-2712
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Fax | 541-459-9129
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IAN L BLACK
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Credential | B.S., R.PH.
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Telephone | 541-459-2712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-7673
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License Number State | OR
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