Healthcare Provider Details

I. General information

NPI: 1417875576
Provider Name (Legal Business Name): LOGAN RENEE BOSSERT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 UNIVERSITY AVE STE 1400
MORGANTOWN WV
26505-3381
US

IV. Provider business mailing address

1056 DUCK RUN RD
GLENVILLE WV
26351-8195
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-7216
  • Fax:
Mailing address:
  • Phone: 681-495-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0015313
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: