Provider Demographics
NPI:1700018975
Name:LOGIUDICE, DAVID (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LOGIUDICE
Suffix:
Gender:M
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 1:175 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1747
Mailing Address - Country:US
Mailing Address - Phone:201-445-2857
Mailing Address - Fax:
Practice Address - Street 1:6126 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2713
Practice Address - Country:US
Practice Address - Phone:718-454-4433
Practice Address - Fax:718-454-8353
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03984400183500000X
NY053252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053252OtherNEW YORK STATE BOARD OF PHARMACY