Provider Demographics
NPI:1477858140
Name:LOGAN, SANDRA T (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:T
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 BEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-8623
Mailing Address - Country:US
Mailing Address - Phone:843-399-7338
Mailing Address - Fax:843-716-7272
Practice Address - Street 1:914 BEAR LAKE DR
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-8623
Practice Address - Country:US
Practice Address - Phone:843-399-7338
Practice Address - Fax:843-716-7272
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6385183500000X
NC15770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist