Provider Demographics
NPI:1578166963
Name:SAGOO, PERMINDER (RPH)
Entity Type:Individual
Prefix:
First Name:PERMINDER
Middle Name:
Last Name:SAGOO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 HIGHWAY 377 S
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2542
Mailing Address - Country:US
Mailing Address - Phone:817-249-4040
Mailing Address - Fax:
Practice Address - Street 1:8660 HIGHWAY 377 S
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2542
Practice Address - Country:US
Practice Address - Phone:817-249-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist