Healthcare Provider Details

I. General information

NPI: 1083331490
Provider Name (Legal Business Name): LOGAN SAXTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W MICHIGAN AVE
MARSHALL MI
49068-1522
US

IV. Provider business mailing address

914 FOREST ST
MARSHALL MI
49068-1325
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-3411
  • Fax:
Mailing address:
  • Phone: 269-967-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302416995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: