Provider Demographics
NPI:1578991774
Name:DALAL, SAGAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAGAR
Middle Name:
Last Name:DALAL
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 1:222 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1913
Mailing Address - Country:US
Mailing Address - Phone:856-468-4876
Mailing Address - Fax:856-415-9458
Practice Address - Street 1:222 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-1913
Practice Address - Country:US
Practice Address - Phone:856-468-4876
Practice Address - Fax:856-415-9458
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02883400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist