Provider Demographics
NPI:1407288673
Name:FISCUS, LOGAN RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:RICHARD
Last Name:FISCUS
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 1:1215 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3706
Mailing Address - Country:US
Mailing Address - Phone:812-890-3372
Mailing Address - Fax:
Practice Address - Street 1:1215 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3706
Practice Address - Country:US
Practice Address - Phone:812-890-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025080A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist