Active NPI
Laird Black
- Pharmacist
- Myrtle Creek, OR
National Provider Identifier
1326391012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 006925
- Practice address
- 821 S Main St
Myrtle Creek, OR 97457-9334 - Phone
- (541) 863-6383
- Fax
- (541) 863-6023
- NPI assigned
- Oct 18, 2012
- Last updated
- Oct 18, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 006925 | OR | Primary |
Addresses
Primary practice location
821 S Main St
Myrtle Creek, OR 97457-9334
Mailing address
821 S Main St
Myrtle Creek, OR 97457-9334
Phone (541) 863-6383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006925 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1326391012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 S MAIN ST",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "974579334",
"telephone_number": "541-863-6383",
"fax_number": "541-863-6023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 S MAIN ST",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "974579334",
"telephone_number": "541-863-6383",
"fax_number": "541-863-6023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "LAIRD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "006925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Creek, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.