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NPI Code Detail

MEDICARE: BETH MARIE BLACK PHARMD

MEDICARE: BETH MARIE 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
1183500000XPharmacist5302046511MI

General Provider Information

NPI Number : 1942874433
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH MARIE BLACK PHARMD
Provider Business Mailing Address
First Line : 10 COLUMBIA AVE E
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49015-3704
Country : US
Telephone Number : 269-962-1965
Fax Number :
Provider Business Practice Location Address
First Line : 10 COLUMBIA AVE E
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49015-3704
Country : US
Telephone Number : 269-962-1965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2021
Last Update Date : 05/18/2021

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