| Doctor Name: | MATTHEW BLACK |
| NPI Number: | 1275923955 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPHT |
| License Number: | 0230022207 |
| Business Practice Address: | 45155 First Colony Way Attn Pharmacy California, MD - 206192416 |
| Business Phone Number: | 3018625342 |
| Business Fax Number: | |
| Mailing Address: | 45155 First Colony Way, Attn Pharmacy CALIFORNIA |
| State: | MD |
| Postal Code: | 206192416 |
| Phone Number: | 3018625342 |
| Fax Number: | |
| NPI Enumeration Date: | 02/02/2015 |
| NPI Last Update Date: | 02/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | 0230022207 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |