Provider Demographics
NPI:1154060267
Name:LOGAN, SARA RAEJON (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RAEJON
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5007
Mailing Address - Country:US
Mailing Address - Phone:918-683-0611
Mailing Address - Fax:
Practice Address - Street 1:410 S 32ND ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5007
Practice Address - Country:US
Practice Address - Phone:918-683-0611
Practice Address - Fax:918-683-0620
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician