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General NPI Number Information
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NPI Number | 1740576206
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Entity Type | Organization
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Legal Business Name | SAGE MED LLC
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 1620 E 8TH ST STE 2 1620 E 8TH ST SUITE 2
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City | WESLACO
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State | TX
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Zip | 78596-5883
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Country | US
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Telephone | 956-351-5322
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Fax | 956-351-5341
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Provider Business Mailing Address
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Address Line | 1620 E 8TH ST STE 2 1620 E 8TH ST SUITE 2
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City | WESLACO
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State | TX
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Zip | 78596-5883
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Country | US
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Telephone | 956-351-5322
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Fax | 956-351-5341
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Authorized Official
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Title or Position | OWNER/PIC
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Name | HENRY FONSECA
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Credential |
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Telephone | 956-857-4823
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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 | 27573
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License Number State | TX
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