Carly Josephine Black, PHARMD
Individual provider Active NPI Pharmacist · Park Rapids, MN
NPI 1609508043 · NPPES record last updated Jun 24, 2022
Key facts
- NPI
- 1609508043
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 125601 (MN)
- Practice address
- 101 Main Ave N
Park Rapids, MN 56470-1511 - Phone
- (218) 732-3342
- NPI assigned
- Jun 24, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125601 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 125601 | MN | Yes |
Addresses
Primary practice location
101 Main Ave N
Park Rapids, MN 56470-1511
Mailing address
2550 18TH St S Apt 201
Fargo, ND 58103-6657
Phone (701) 219-3218
Other providers in Park Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.