Healthcare Provider Details

I. General information

NPI: 1962175216
Provider Name (Legal Business Name): CHERYL LYNNE CALDWELL-LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 CITY AVE
PHILADELPHIA PA
19131-1435
US

IV. Provider business mailing address

1735 N REDFIELD ST
PHILADELPHIA PA
19151-3922
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-2116
  • Fax: 215-877-5064
Mailing address:
  • Phone: 215-512-4847
  • Fax: 215-877-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: