Provider Demographics
NPI:1942690631
Name:LOGAN-MCDERMOTT, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LOGAN-MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17232 133RD AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3931
Mailing Address - Country:US
Mailing Address - Phone:917-539-5942
Mailing Address - Fax:718-525-6461
Practice Address - Street 1:17232 133RD AVE APT 1A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3931
Practice Address - Country:US
Practice Address - Phone:917-539-5942
Practice Address - Fax:718-525-6461
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician