Basic Information
| Provider Information | |||||||||
| NPI: | 1053751867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGAN | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8710 CAMERON ST | ||||||||
| Address2: | UNIT 1314 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209103703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604568333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 305 HOSPITAL DR | ||||||||
| Address2: | OUTPATIENT ANTICOAGULATION CLINIC | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107874675 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 20288 | MD | Y | Pharmacy Service Providers | Pharmacist | 183500000X | PCT.0011411 | CT | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH232982 | MA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 0202209207 | VA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.