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1093545014
RICHARD WAYNE BLACK
IDAHO FALLS, ID
NPI
1093545014
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
183500000X Pharmacist
(Licence: ID 7161471)
Enumeration Date
2024-08-05
Last Update Date
2024-08-05
Business Address
RICHARD WAYNE BLACK
2325 CORONADO ST
IDAHO FALLS, ID 83404-7407
Phone number: 208-557-2738
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Mailing Address
RICHARD WAYNE BLACK
2325 CORONADO ST
IDAHO FALLS, ID 83404-7407
Phone number:
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