Provider Demographics
NPI:1114522380
Name:LOGAN, TODD BARROW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:BARROW
Last Name:LOGAN
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 1:4318 HAZEL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2607
Mailing Address - Country:US
Mailing Address - Phone:561-329-2986
Mailing Address - Fax:
Practice Address - Street 1:4603 OKEECHOBEE BLVD STE 118
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4636
Practice Address - Country:US
Practice Address - Phone:561-268-2552
Practice Address - Fax:561-328-7586
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS521351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist