Individual
MR. ERIC LEE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH
Contact information
Practice address
2339 BROADWAY ST, MOUNT VERNON, IL 62864-2925
(618) 242-8776
(618) 242-0424
Mailing address
1505 PACE AVE, MOUNT VERNON, IL 62864-2834
(618) 614-5505
(618) 242-0424
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371268476001
—
IL
Enumeration date
08/31/2006
Last updated
07/09/2007
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