Provider Demographics
NPI:1548599327
Name:SAGI, SURYANARAYANA R
Entity Type:Individual
Prefix:
First Name:SURYANARAYANA
Middle Name:R
Last Name:SAGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 GREENFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9170
Mailing Address - Country:US
Mailing Address - Phone:516-410-8886
Mailing Address - Fax:
Practice Address - Street 1:625 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-7890
Practice Address - Country:US
Practice Address - Phone:516-410-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist