Provider Demographics
NPI:1518475409
Name:SAGUN, IRINA (RPH)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SAGUN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BRIGHTON BEACH AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5904
Mailing Address - Country:US
Mailing Address - Phone:917-386-8663
Mailing Address - Fax:
Practice Address - Street 1:4508 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2018
Practice Address - Country:US
Practice Address - Phone:718-686-9999
Practice Address - Fax:718-686-9998
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03888600183500000X
NY065016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist