Provider Demographics
NPI:1063500882
Name:LOGANS DISCOUNT DRUGS INC
Entity Type:Organization
Organization Name:LOGANS DISCOUNT DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-983-7800
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:129 SOUTH NEWBERGER
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-0697
Mailing Address - Country:US
Mailing Address - Phone:662-983-7800
Mailing Address - Fax:662-983-7806
Practice Address - Street 1:129 SOUTH NEWBERGER
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-0697
Practice Address - Country:US
Practice Address - Phone:662-983-7800
Practice Address - Fax:662-983-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01291011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330263Medicaid
MS00440635OtherMEDICAID DME #
2510611Medicare UPIN
MS0330263Medicaid