Individual
ANDREW PATRICK BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
79795 HIGHWAY 111, LA QUINTA, CA 92253-4756
(760) 342-0656
Mailing address
79795 HIGHWAY 111, LA QUINTA, CA 92253-4756
(760) 342-0656
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
47257
CA
Other
Enumeration date
03/10/2012
Last updated
03/10/2012
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