Provider Demographics
NPI:1144828674
Name:DURST, LOGAN DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:DOUGLAS
Last Name:DURST
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 1:9939 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5311
Mailing Address - Country:US
Mailing Address - Phone:513-793-1620
Mailing Address - Fax:513-793-1590
Practice Address - Street 1:9939 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5311
Practice Address - Country:US
Practice Address - Phone:513-793-1620
Practice Address - Fax:513-793-1590
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0201111835P0018X
OH034392751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist