Individual
MR. IAN LEONARD BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
113 E CENTRAL AVE, SUTHERLIN, OR 97479-9556
(541) 459-2712
(541) 459-9129
Mailing address
PO BOX 280, SUTHERLIN, OR 97479-0280
(541) 459-2712
(541) 459-9129
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0007673-P
OR
Other
Enumeration date
06/19/2013
Last updated
06/19/2013
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