MEDICARE: DR. JORDAN LOGGINS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH028912	GA

General Provider Information

NPI Number	:	1033584859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN LOGGINS PHARM.D.

Provider Business Mailing Address
First Line	:	837 SUMMER SPRINGS CT
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-4656
Country	:	US
Telephone Number	:	678-936-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	5231 CLEVELAND HIGHWAY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527
Country	:	US
Telephone Number	:	770-983-2130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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