MEDICARE: MR. TIM A LOGAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S014829	AZ

General Provider Information

NPI Number	:	1437480795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIM A LOGAN PHARMD

Provider Business Mailing Address
First Line	:	4570 E CACTUS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7702
Country	:	US
Telephone Number	:	480-308-7053
Fax Number	:	480-308-7050

Provider Business Practice Location Address
First Line	:	4570 E CACTUS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7702
Country	:	US
Telephone Number	:	480-308-7053
Fax Number	:	480-308-7050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	10/20/2022

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