Michael Logan, RPH
Individual provider Active NPI Pharmacist · Calimesa, CA
NPI 1811037658 · NPPES record last updated Jun 5, 2009
Key facts
- NPI
- 1811037658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 27426 (CA)
- Practice address
- 1151 Calimesa Blvd
Calimesa, CA 92320-1549 - Phone
- (909) 795-2457
- Fax
- (909) 795-7622
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27426 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Star Drug Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27426 | CA | Yes |
Addresses
Primary practice location
1151 Calimesa Blvd
Calimesa, CA 92320-1549
Mailing address
1151 Calimesa Blvd
Calimesa, CA 92320-1549
Phone (909) 795-2457
Other providers in Calimesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.