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NPI Code Detail

MEDICARE: SHAYLA BLACK

MEDICARE: SHAYLA BLACK
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
1183500000XPharmacist43369SC

General Provider Information

NPI Number : 1619617305
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAYLA BLACK
Provider Business Mailing Address
First Line : 225 FERNVIEW DR
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-9067
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 BULTMAN DR
Second Line :
City : SUMTER
State : SC
Zip : 29150-2514
Country : US
Telephone Number : 803-305-6192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 03/30/2022

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Directions to “ SHAYLA BLACK ” Practice Location

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