Provider Demographics
NPI:1801564943
Name:SATTERFIELD, LOGAN RAE
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:RAE
Last Name:SATTERFIELD
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 1:1733 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4514
Mailing Address - Country:US
Mailing Address - Phone:601-485-2218
Mailing Address - Fax:
Practice Address - Street 1:1733 2ND ST S
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4514
Practice Address - Country:US
Practice Address - Phone:601-485-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-100361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist