Provider Demographics
NPI:1073863395
Name:BLACK, SARAH DELELLO (RPH)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:DELELLO
Last Name:BLACK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 EAST HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651
Mailing Address - Country:US
Mailing Address - Phone:864-385-0592
Mailing Address - Fax:
Practice Address - Street 1:590 EAST HOWELL RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651
Practice Address - Country:US
Practice Address - Phone:864-385-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist