Provider Demographics
NPI:1225234487
Name:BLACK, JAMES LEWIS JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEWIS
Last Name:BLACK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:707 MARCUS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-4309
Mailing Address - Country:US
Mailing Address - Phone:540-483-8513
Mailing Address - Fax:
Practice Address - Street 1:2001 CRYSTAL SPRING AVE, CARILION MEDICAL CENTER PHCY
Practice Address - Street 2:SUITE 110
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-853-0905
Practice Address - Fax:540-853-0910
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist