MEDICARE: CARL ROBERT BLACK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS68068	FL

General Provider Information

NPI Number	:	1235022849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL ROBERT BLACK PHARMD

Provider Business Mailing Address
First Line	:	4901 NW 17TH WAY STE 302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 NW 17TH WAY STE 302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3772
Country	:	US
Telephone Number	:	888-536-9963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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