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Individual

LEA WILLIAMSON BLACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHARMACIST

Contact information

Practice address
1907 SE WASHINGTON ST, IDABEL, OK 74745-5253
(580) 286-3323
(580) 286-2396
Mailing address
3408 STATE HIGHWAY 37, GARVIN, OK 74736-5314
(580) 212-8678

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11827
OK

Other

Enumeration date
10/27/2020
Last updated
10/27/2020
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