Individual
LOGAN M KISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 W MAIN ST, OTTAWA, OH 45875-1725
(419) 523-6030
Mailing address
10000 PARK PLAZA DR APT 301, PITTSBURGH, PA 15229-3125
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
03439762
OH
Other
Enumeration date
07/07/2020
Last updated
07/13/2020
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