Provider Demographics
NPI:1417730458
Name:LOGUE, MEAGAN RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:RAE
Last Name:LOGUE
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 1:1325 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:RENTZ
Mailing Address - State:GA
Mailing Address - Zip Code:31075-3454
Mailing Address - Country:US
Mailing Address - Phone:770-825-3304
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:770-825-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0272471835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist