Provider Demographics
NPI:1053535138
Name:LOGAN, RODNEY DALTON (BS)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:DALTON
Last Name:LOGAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2230 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:LEIGHTON
Mailing Address - State:AL
Mailing Address - Zip Code:35646-3819
Mailing Address - Country:US
Mailing Address - Phone:256-446-6767
Mailing Address - Fax:256-446-2585
Practice Address - Street 1:14001 HIGHWAY 43 STE 13
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2849
Practice Address - Country:US
Practice Address - Phone:256-331-1919
Practice Address - Fax:251-331-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL8045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist