Individual
RICHARD WAYNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2738
Mailing address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7161471
ID
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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