Provider Demographics
NPI:1033248711
Name:BLACK, EDDIE LAMAR JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:LAMAR
Last Name:BLACK
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3654
Mailing Address - Country:US
Mailing Address - Phone:803-608-0445
Mailing Address - Fax:
Practice Address - Street 1:718 MILTON AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3654
Practice Address - Country:US
Practice Address - Phone:803-608-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist