Individual
CARLOS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
864 WILSON DR STE B, RIDGELAND, MS 39157-4512
(601) 957-9174
Mailing address
204 WINDROSE DR, MADISON, MS 39110-8005
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-13962
MS
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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