Provider Demographics
NPI:1962136036
Name:OWENS, LOGAN TATE (PHARMD)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:TATE
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520A TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2919
Mailing Address - Country:US
Mailing Address - Phone:803-849-1709
Mailing Address - Fax:
Practice Address - Street 1:368 S PIKE W
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2664
Practice Address - Country:US
Practice Address - Phone:803-830-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist