Provider Demographics
NPI:1689362238
Name:MEYER, SAGE ANNA MARIE
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:ANNA MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 S 97TH CT APT 3100
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4599
Mailing Address - Country:US
Mailing Address - Phone:918-724-8726
Mailing Address - Fax:
Practice Address - Street 1:11350 WICKERSHAM BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-6979
Practice Address - Country:US
Practice Address - Phone:402-881-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist