Provider Demographics
NPI:1801427067
Name:WOESSNER, LOGAN NICHOLAS (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:NICHOLAS
Last Name:WOESSNER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 GUADALUPE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1330
Mailing Address - Country:US
Mailing Address - Phone:512-354-3696
Mailing Address - Fax:512-354-3695
Practice Address - Street 1:3701 GUADALUPE ST STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1330
Practice Address - Country:US
Practice Address - Phone:512-354-3696
Practice Address - Fax:512-354-3695
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72520183500000X
TX39821390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes183500000XPharmacy Service ProvidersPharmacist