Individual
MARIAH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
9211 E 21ST ST N, WICHITA, KS 67206-2900
(316) 609-4501
Mailing address
10506 W HAYDEN ST, WICHITA, KS 67209-3533
(316) 650-8333
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
1-100805
KS
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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