Provider Demographics
NPI:1578019345
Name:LOGSDON, ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:LOGSDON
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 1:491 KING RD
Mailing Address - Street 2:
Mailing Address - City:BARLOW
Mailing Address - State:KY
Mailing Address - Zip Code:42024-9739
Mailing Address - Country:US
Mailing Address - Phone:270-564-4612
Mailing Address - Fax:
Practice Address - Street 1:409 COURT ST
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:KY
Practice Address - Zip Code:42087-9444
Practice Address - Country:US
Practice Address - Phone:270-335-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist