Healthcare Provider Details

I. General information

NPI: 1073438800
Provider Name (Legal Business Name): LOGAN GRACE DALFIUME PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHASON LN
WEST MONROE LA
71291-1910
US

IV. Provider business mailing address

110 CHASON LN
WEST MONROE LA
71291-1910
US

V. Phone/Fax

Practice location:
  • Phone: 318-789-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026378
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: