Provider Demographics
NPI:1437480795
Name:LOGAN, TIM A (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:A
Last Name:LOGAN
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 1:4570 E CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7702
Mailing Address - Country:US
Mailing Address - Phone:480-308-7053
Mailing Address - Fax:480-308-7050
Practice Address - Street 1:4570 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7702
Practice Address - Country:US
Practice Address - Phone:480-308-7053
Practice Address - Fax:480-308-7050
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist