Provider Demographics
NPI:1376303354
Name:SAGP PHARMA LLC
Entity Type:Organization
Organization Name:SAGP PHARMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOBRIAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-388-8997
Mailing Address - Street 1:13346 OCEAN MIST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5204
Mailing Address - Country:US
Mailing Address - Phone:407-388-8997
Mailing Address - Fax:
Practice Address - Street 1:1371 S WALNUT ST STE 1400
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4426
Practice Address - Country:US
Practice Address - Phone:407-388-8997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy