Provider Demographics
NPI:1053175471
Name:ADAMS, LOGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LILY RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04429-4825
Mailing Address - Country:US
Mailing Address - Phone:207-812-8919
Mailing Address - Fax:
Practice Address - Street 1:226 HIGH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1742
Practice Address - Country:US
Practice Address - Phone:207-664-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist