Healthcare Provider Details

I. General information

NPI: 1073522421
Provider Name (Legal Business Name): LOGAN & SEILER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S MAIN ST
CHARLESTON MO
63834-1644
US

IV. Provider business mailing address

406 S MAIN ST
CHARLESTON MO
63834-1644
US

V. Phone/Fax

Practice location:
  • Phone: 573-683-3307
  • Fax: 573-683-3308
Mailing address:
  • Phone: 573-683-3307
  • Fax: 573-683-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number003350
License Number StateMO

VIII. Authorized Official

Name: RICHARD LOGAN
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 573-683-3307