Provider Demographics
NPI:1912211053
Name:LOGSDON, ROB (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROB
Middle Name:
Last Name:LOGSDON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6947
Mailing Address - Country:US
Mailing Address - Phone:602-305-4421
Mailing Address - Fax:602-305-4423
Practice Address - Street 1:2250 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6947
Practice Address - Country:US
Practice Address - Phone:602-305-4421
Practice Address - Fax:602-305-4423
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO12051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist