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NPI Code Detail

MEDICARE: DR. LOGAN ROBERTS MD, PHARMD

MEDICARE: DR. LOGAN ROBERTS MD, PHARMD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2183500000XPharmacistPST.023915LA

General Provider Information

NPI Number : 1972173326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOGAN ROBERTS MD, PHARMD
Provider Business Mailing Address
First Line : 10000 HYDE PL
Second Line :
City : RIVER RIDGE
State : LA
Zip : 70123-1522
Country : US
Telephone Number : 225-454-9332
Fax Number :
Provider Business Practice Location Address
First Line : 12502 HIGHWAY 431
Second Line :
City : SAINT AMANT
State : LA
Zip : 70774-3418
Country : US
Telephone Number : 225-644-7288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2021
Last Update Date : 04/19/2025

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