Individual
MR. EDSEL RAY BLACK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
184 W KYTLE ST STE A, CLEVELAND, GA 30528-9607
(706) 219-2626
(706) 219-1253
Mailing address
184 W KYTLE ST, CLEVELAND, GA 30528-1330
(706) 219-2626
(706) 219-1253
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH009632
GA
Other
Enumeration date
09/25/2010
Last updated
04/19/2022
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