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General NPI Number Information
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NPI Number | 1376303354
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Entity Type | Organization
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Legal Business Name | SAGP PHARMA LLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 1371 S WALNUT ST STE 1400
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City | STARKE
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State | FL
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Zip | 32091-4426
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Country | US
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Telephone | 407-388-8997
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Fax |
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Provider Business Mailing Address
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Address Line | 13346 OCEAN MIST DR
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5204
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Country | US
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Telephone | 407-388-8997
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Fax |
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Authorized Official
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Title or Position | AO
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Name | MS. SANDI GHOBRIAL
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Credential | RPH
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Telephone | 407-388-8997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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