Provider Demographics
NPI:1467554931
Name:LOGAN, LEA ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:ANN
Last Name:LOGAN
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 1:2435 COUNTY ROAD 44550
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-0929
Mailing Address - Country:US
Mailing Address - Phone:903-784-6125
Mailing Address - Fax:
Practice Address - Street 1:707 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-783-1131
Practice Address - Fax:903-783-1186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist