Organization
SAGE PHARMACY AND STORES LLC
Active
Other names
SAGE PHARMACY AND STORES, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SURVAM PATEL (PRESIDENT)
(512) 628-1090
Entity
Organization
Contact information
Practice address
2500 S LAKELINE BLVD STE 202, CEDAR PARK, TX 78613-2969
(512) 628-1090
(512) 628-1090
Mailing address
2500 S LAKELINE BLVD STE 202, CEDAR PARK, TX 78613-2969
(512) 628-1090
(512) 628-1090
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
27581
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148225
—
TX
01
—
2131770
PK
—
Enumeration date
05/10/2011
Last updated
10/20/2023
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