Provider Demographics
NPI:1033431622
Name:LOGAR PHARMACY
Entity Type:Organization
Organization Name:LOGAR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARAMCY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HEDAYATULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALYAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:509-967-5037
Mailing Address - Street 1:PO BOX 4218
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-4003
Mailing Address - Country:US
Mailing Address - Phone:509-967-5037
Mailing Address - Fax:
Practice Address - Street 1:515 9TH ST
Practice Address - Street 2:SUIT A
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320
Practice Address - Country:US
Practice Address - Phone:509-967-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000218053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1970Medicaid