Provider Demographics
NPI:1053751867
Name:LOGAN, JILL KATHLEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:KATHLEEN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8710 CAMERON ST
Mailing Address - Street 2:UNIT 1314
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3703
Mailing Address - Country:US
Mailing Address - Phone:860-456-8333
Mailing Address - Fax:
Practice Address - Street 1:305 HOSPITAL DR
Practice Address - Street 2:OUTPATIENT ANTICOAGULATION CLINIC
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5805
Practice Address - Country:US
Practice Address - Phone:410-787-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20288183500000X
CTPCT.0011411183500000X
MAPH232982183500000X
VA0202209207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist