Provider Demographics
NPI:1033584859
Name:LOGGINS, JORDAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:LOGGINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 SUMMER SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:PENDERGRASS
Mailing Address - State:GA
Mailing Address - Zip Code:30567-4656
Mailing Address - Country:US
Mailing Address - Phone:678-936-3308
Mailing Address - Fax:
Practice Address - Street 1:5231 CLEVELAND HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527
Practice Address - Country:US
Practice Address - Phone:770-983-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist