Healthcare Provider Details

I. General information

NPI: 1003391640
Provider Name (Legal Business Name): LOGAN HUANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2018
Last Update Date: 09/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 BROWNSVILLE RD
TREVOSE PA
19053-3502
US

IV. Provider business mailing address

7236 LARGE ST
PHILADELPHIA PA
19149-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-322-4107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452379
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: