| NPI | 1124847074 |
|---|---|
| Doing Business As | BLACK OAK PHARMACY LTC |
| Entity Type | Organization |
| Authorized Contact | JEFFREY SHANE HARRELL Owner 360-244-5984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2024-10-08 |