Black, Eric Lee

Black, Eric Lee is an individual health care provider with primary practice located at 2339 Broadway St , Mount Vernon IL 62864-2925. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Black, Eric Lee can be contacted via phone (618) 242-8776.

Contact Information

Primary practice address
2339 Broadway St Mount Vernon IL 62864-2925
Phone: (618) 242-8776
Fax: (618) 242-0424
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X Illinois

Profile Details

NPI number 1598877961
LBN Legal business name Black, Eric Lee
Credentials R.PH
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1598877961 NPPES
Illinois MEDICAID 371268476001

Popular Providers