Provider Demographics
NPI:1194005074
Name:BLACK, JOSEPH LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LYNN
Last Name:BLACK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 E ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4043
Mailing Address - Country:US
Mailing Address - Phone:704-289-5041
Mailing Address - Fax:704-289-9537
Practice Address - Street 1:396 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4043
Practice Address - Country:US
Practice Address - Phone:704-289-5041
Practice Address - Fax:704-289-9537
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist