Provider Demographics
NPI:1508962531
Name:SAGEN'S PHARMACY INC
Entity Type:Organization
Organization Name:SAGEN'S PHARMACY INC
Other - Org Name:RAYMOND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-642-3133
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-2509
Mailing Address - Country:US
Mailing Address - Phone:360-942-2634
Mailing Address - Fax:360-942-5132
Practice Address - Street 1:515 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2509
Practice Address - Country:US
Practice Address - Phone:360-942-2634
Practice Address - Fax:360-942-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00001625183500000X
WACF000593613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6060602Medicaid
WA0312780001Medicare NSC