Provider Demographics
NPI:1114539756
Name:ROSS, LOGAN HALEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:HALEY
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:MEREDITH
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3693 BURGESS GOWER RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37032-5545
Mailing Address - Country:US
Mailing Address - Phone:615-681-7763
Mailing Address - Fax:
Practice Address - Street 1:1211 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1338
Practice Address - Country:US
Practice Address - Phone:615-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021814183500000X
TN44253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist