Provider Demographics
NPI:1992426415
Name:BECKETT, LOGAN ABRAHAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:ABRAHAM
Last Name:BECKETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29423 MAURICE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3753
Mailing Address - Country:US
Mailing Address - Phone:586-222-3652
Mailing Address - Fax:
Practice Address - Street 1:18640 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1945
Practice Address - Country:US
Practice Address - Phone:586-447-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist