Provider Demographics
NPI:1770661282
Name:SGP INCORPORATED
Entity Type:Organization
Organization Name:SGP INCORPORATED
Other - Org Name:LAS PHARMACY AND MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-771-2633
Mailing Address - Street 1:7705 S ATLANTIC BLVD
Mailing Address - Street 2:H
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-771-2633
Mailing Address - Fax:323-771-1718
Practice Address - Street 1:7705 S ATLANTIC BLVD
Practice Address - Street 2:H
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-771-2633
Practice Address - Fax:323-771-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
CA491693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1993883OtherPK