Provider Demographics
NPI:1780906958
Name:LOGUE, PAULA RENEE
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:RENEE
Last Name:LOGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30352 KASTEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-8728
Mailing Address - Country:US
Mailing Address - Phone:515-993-4270
Mailing Address - Fax:
Practice Address - Street 1:10331 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6472
Practice Address - Country:US
Practice Address - Phone:515-225-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist