Provider Demographics
NPI:1073683835
Name:LOGAN, MARIAN FRENCH (RPH)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:FRENCH
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1422
Mailing Address - Country:US
Mailing Address - Phone:540-459-2136
Mailing Address - Fax:540-459-4638
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1422
Practice Address - Country:US
Practice Address - Phone:540-459-2136
Practice Address - Fax:540-459-4638
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist