Provider Demographics
NPI:1295460186
Name:SAKS GA LLC
Entity Type:Organization
Organization Name:SAKS GA LLC
Other - Org Name:15MINRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-226-7622
Mailing Address - Street 1:PO BOX 600841
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0841
Mailing Address - Country:US
Mailing Address - Phone:912-226-7622
Mailing Address - Fax:
Practice Address - Street 1:2714 OSBORNE RD STE J
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4050
Practice Address - Country:US
Practice Address - Phone:912-226-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy