Individual provider Active NPI

Jeremy Logan, PHARM.D

  • Pharmacist
  • Newcastle, OK
National Provider Identifier
1154516912
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
14595 Issued in OK
Practice address
3232 Tri City Dr
Newcastle, OK 73065-6324
Phone
(405) 387-5006
Fax
(405) 387-5092
NPI assigned
Sep 13, 2007
Last updated
Aug 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 14595 OK Primary

Addresses

Primary practice location

3232 Tri City Dr
Newcastle, OK 73065-6324

Mailing address

3232 Tri City Dr
Newcastle, OK 73065-6324
Phone (405) 387-5006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
14595OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Mar 20, 2022 Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1154516912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 TRI CITY DR",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656324",
            "telephone_number": "405-387-5006",
            "fax_number": "405-387-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 TRI CITY DR",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656324",
            "telephone_number": "405-387-5006",
            "fax_number": "405-387-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "PHARM.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-13",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "14595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newcastle, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.