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General NPI Number Information
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NPI Number | 1235731019
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Entity Type | Individual
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Provider Name | LOGAN WAGNER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1795 COLUMBUS AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1765
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Country | US
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Telephone | 740-335-6162
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Fax | 740-335-1618
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Provider Business Mailing Address
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Address Line | 160 BUTTERNUT PASS
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City | COMMERCIAL POINT
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State | OH
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Zip | 43116-9748
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Country | US
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Telephone | 330-687-7041
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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 | 03233013
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License Number State | OH
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