MR. ERIC LEE BLACK (NPI# 1598877961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598877961 |
| Entity Type | Individual |
| Full Name | MR. ERIC LEE BLACK |
| Credential | R.PH |
| Practice Address |
2339 Broadway St Mount Vernon IL 62864-2925 |
| Mailing Address |
1505 Pace Ave Mount Vernon IL 62864-2834 |
| Practice Telephone | 6182428776 |
| Practice Fax Number | 6182420424 |
| Mailing Telephone | 6186145505 |
| Mailing Fax Number | 6182420424 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | IL | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 371268476001 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174000285 | Eric Black | Pharmacist | 657 Us Highway 101 N, Crescent City, CA 95531-2306 | 2018-07-20 |
| 1730526013 | Eric J Black | Counselor | 1261 Chaffer Dr, Rochester Hills, MI 48306-3714 | 2013-05-28 |
| 1962874792 | Eric Black | Physician Assistant | 1650 Dixwell Ave, Hamden, CT 06514-3615 | 2015-10-20 |
| 1831528066 | Eric Black | Social Worker | 51 Market St, Bangor, PA 18013-1901 | 2013-11-07 |
| 1982863338 | Eric M Black | Orthopaedic Surgery | 140 Park Ave, Florham Park, NJ 07932-1049 | 2008-06-02 |
| 1245323005 | Eric Richard Black | Psychiatry & Neurology | 901 W Jefferson St, Springfield, IL 62702-4833 | 2006-10-02 |
| 1154364305 | Eric Black | Dentist | 2920 N 4th St, Flagstaff, AZ 86004-1816 | 2006-06-14 |
| Street Address |
2339 BROADWAY ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417923012 | Mt Vernon Community Pharmacy Inc | Pharmacy | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2006-02-24 |
| 1811543648 | Mt Vernon Community Pharmacy Inc | Pharmacy | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2019-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780296509 | Jordan Lee Erickson | Pharmacist | 2109 E Broadway, Mount Vernon, WA 98274-4628 | 2020-08-21 |
| 1851920342 | Branda Truong | Pharmacist | 306 Texas Highway 37, Mount Vernon, TX 75457-3112 | 2020-04-06 |
| 1003449851 | Rachel Octavia Wylie | Pharmacist | 1226 Mulberry St, Mount Vernon, IN 47620-1358 | 2020-02-20 |
| 1689180184 | Samuel Cooke Ingraham IIi | Pharmacist | 618 E High St, Mount Vernon, OH 43050-2747 | 2017-12-19 |
| 1689120412 | Kendall Keith Kilbourne | Pharmacist | 410 Richmond, Mount Vernon, KY 40456-0796 | 2016-08-31 |
| 1336502996 | Timothy Lynn | Pharmacist | 3404 Broadway St, Mount Vernon, IL 62864-2267 | 2016-03-31 |
| 1548676323 | Tina Chang-yip | Pharmacist | 211 E Sandford Blvd, Mount Vernon, NY 10550-4623 | 2014-07-01 |
| 1477835114 | Sara Elizabeth Koebele | Pharmacist | 3001 Broadway St, Mount Vernon, IL 62864-2361 | 2011-09-19 |
| 1881976355 | Shimrote Ishaque | Pharmacist | 424 E. College Wa, Mount Vernon, WA 98273 | 2011-09-12 |
| 1144518143 | Hebat Allah Bakhach | Pharmacist | 242 E College Way, Mount Vernon, WA 98273-5432 | 2011-07-12 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.