Provider Demographics
NPI:1346918778
Name:WALKER, LOGAN MULLIS
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MULLIS
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 ALTAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4607
Mailing Address - Country:US
Mailing Address - Phone:912-266-8140
Mailing Address - Fax:912-266-8141
Practice Address - Street 1:3010 ALTAMA AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4607
Practice Address - Country:US
Practice Address - Phone:912-266-8140
Practice Address - Fax:912-266-8141
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist