Provider Demographics
NPI:1992042543
Name:LOGSDON, FELICIA (RPH)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 SANDY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3068
Mailing Address - Country:US
Mailing Address - Phone:770-578-6800
Mailing Address - Fax:
Practice Address - Street 1:3605 SANDY PLAINS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3066
Practice Address - Country:US
Practice Address - Phone:770-578-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist