Individual
DR. LOGAN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 S WESTWOOD BLVD, POPLAR BLUFF, MO 63901-5519
(573) 686-6539
Mailing address
976 SUNNY VALLEY LN, POPLAR BLUFF, MO 63901-6679
(573) 944-1691
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2016020572
MO
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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