Healthcare Provider Details

I. General information

NPI: 1477858140
Provider Name (Legal Business Name): SANDRA T LOGAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 BEAR LAKE DR
LONGS SC
29568-8623
US

IV. Provider business mailing address

914 BEAR LAKE DR
LONGS SC
29568-8623
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-7338
  • Fax: 843-716-7272
Mailing address:
  • Phone: 843-399-7338
  • Fax: 843-716-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6385
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15770
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: