Healthcare Provider Details

I. General information

NPI: 1487376992
Provider Name (Legal Business Name): ANN LOGAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OLD GREENSBORO RD
KERNERSVILLE NC
27284-6855
US

IV. Provider business mailing address

116 CLAYTON DR
MOCKSVILLE NC
27028-6142
US

V. Phone/Fax

Practice location:
  • Phone: 336-791-4995
  • Fax: 855-270-7347
Mailing address:
  • Phone: 336-399-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: