Provider Demographics
NPI:1356826531
Name:LOGSDON, KATLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
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 1:48 WESTMINISTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2414
Mailing Address - Country:US
Mailing Address - Phone:301-268-9886
Mailing Address - Fax:
Practice Address - Street 1:17548 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-9797
Practice Address - Country:US
Practice Address - Phone:304-329-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist