Provider Demographics
NPI:1164055190
Name:LOGSDON, ALICIA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 LANE CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-7761
Mailing Address - Country:US
Mailing Address - Phone:606-875-4873
Mailing Address - Fax:
Practice Address - Street 1:90 STONEGATE CTR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6212
Practice Address - Country:US
Practice Address - Phone:606-678-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0149281835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist