Provider Demographics
NPI:1033842372
Name:SAI ROOSEVELT LLC
Entity Type:Organization
Organization Name:SAI ROOSEVELT LLC
Other - Org Name:ROOSEVELT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN - CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:HIMANSHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-646-0207
Mailing Address - Street 1:4615 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-1631
Mailing Address - Country:US
Mailing Address - Phone:210-646-0207
Mailing Address - Fax:210-568-4806
Practice Address - Street 1:3708 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2935
Practice Address - Country:US
Practice Address - Phone:210-646-0207
Practice Address - Fax:210-568-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy