Provider Demographics
NPI:1558408187
Name:LOGAN, RICHARD NORWOOD III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NORWOOD
Last Name:LOGAN
Suffix:III
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 1:406 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1644
Mailing Address - Country:US
Mailing Address - Phone:573-683-3307
Mailing Address - Fax:573-683-3308
Practice Address - Street 1:406 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1644
Practice Address - Country:US
Practice Address - Phone:573-683-3307
Practice Address - Fax:573-683-3308
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist