Healthcare Provider Details

I. General information

NPI: 1164013512
Provider Name (Legal Business Name): SAGAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 EAST AVE
SCHULENBURG TX
78956-1611
US

IV. Provider business mailing address

38 EAST AVE
SCHULENBURG TX
78956-1611
US

V. Phone/Fax

Practice location:
  • Phone: 979-743-3265
  • Fax: 979-743-2010
Mailing address:
  • Phone: 979-743-3265
  • Fax: 979-743-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: