Provider Demographics
NPI:1811608524
Name:BLACK, JOSEPH SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SCOTT
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 1:1039 E HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4757
Mailing Address - Country:US
Mailing Address - Phone:225-647-4182
Mailing Address - Fax:844-337-6197
Practice Address - Street 1:1039 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4757
Practice Address - Country:US
Practice Address - Phone:225-647-4182
Practice Address - Fax:844-337-6197
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46821183500000X
LAPST.0015253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.0015253OtherLOUISIANA PHARMACY LICENSE ID
TX46821OtherTEXAS PHARMACY LICENSE ID