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General NPI Number Information
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NPI Number | 1417730458
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Entity Type | Individual
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Provider Name | MEAGAN RAE LOGUE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1826 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3620
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Country | US
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Telephone | 770-825-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 PAYNE RD
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City | RENTZ
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State | GA
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Zip | 31075-3454
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Country | US
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Telephone | 770-825-3304
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH027247
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License Number State | GA
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