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General NPI Number Information
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NPI Number | 1942083399
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Entity Type | Individual
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Provider Name | LOGAN PICKETT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 1405 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1060
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Country | US
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Telephone | 404-785-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 720 RALPH MCGILL BLVD NE UNIT 517
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City | ATLANTA
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State | GA
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Zip | 30312-1198
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Country | US
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Telephone | 731-345-0060
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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 | RPH033657
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License Number State | GA
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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 | 067916
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License Number State | NY
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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 | 66939
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License Number State | TX
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