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General NPI Number Information
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NPI Number | 1053751867
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Entity Type | Individual
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Provider Name | JILL KATHLEEN LOGAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 305 HOSPITAL DR OUTPATIENT ANTICOAGULATION CLINIC
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5805
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Country | US
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Telephone | 410-787-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 8710 CAMERON ST UNIT 1314
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City | SILVER SPRING
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State | MD
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Zip | 20910-3703
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Country | US
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Telephone | 860-456-8333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20288
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0011411
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH232982
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202209207
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License Number State | VA
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