Organization
SAGE MED LLC
Active
Organization
SAGE MED LLC
Active
Other names
SAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY FONSECA (OWNER/PIC)
(956) 857-4823
Entity
Organization
Contact information
Practice address
1620 E 8TH ST STE 2, 1620 E 8TH ST SUITE 2, WESLACO, TX 78596-5883
(956) 351-5322
(956) 351-5341
Mailing address
1620 E 8TH ST STE 2, 1620 E 8TH ST SUITE 2, WESLACO, TX 78596-5883
(956) 351-5322
(956) 351-5341
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27573
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146434
—
TX
01
—
5903617
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/23/2011
Last updated
08/29/2011
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