Individual
DR. SCOTTY RAY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
7670 US HIGHWAY 377 S, TISHOMINGO, OK 73460-4460
(580) 371-5318
Mailing address
7670 US HIGHWAY 377 S, TISHOMINGO, OK 73460-4460
(580) 371-5318
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15142
OK
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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