Healthcare Provider Details

I. General information

NPI: 1033431622
Provider Name (Legal Business Name): LOGAR PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 9TH ST SUIT A
BENTON CITY WA
99320
US

IV. Provider business mailing address

PO BOX 4218
WEST RICHLAND WA
99353-4003
US

V. Phone/Fax

Practice location:
  • Phone: 509-967-5037
  • Fax:
Mailing address:
  • Phone: 509-967-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00021805
License Number StateWA

VIII. Authorized Official

Name: MR. HEDAYATULLAH JALALYAR
Title or Position: PHARAMCY MANAGER
Credential: PHARM D
Phone: 509-967-5037