Individual
LOGAN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM. D
Contact information
Practice address
2310 CLAY ST, VICKSBURG, MS 39183-3123
(601) 661-5856
Mailing address
107 ASHFORD DR APT 2723, WEST MONROE, LA 71291-7916
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
010895
MS
183500000X
Pharmacist
018795
LA
Other
Enumeration date
04/16/2011
Last updated
04/16/2011
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