Individual
JANE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12400 PRIVATE DR 5308, ROLLA, MO 65401
(573) 341-9404
(573) 341-9403
Mailing address
PO BOX 1007, ROLLA, MO 65402-1007
(573) 341-9404
(573) 341-9403
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2000146994
MO
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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