Provider Demographics
NPI:1902417884
Name:SAGE, STEPHEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SAGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N POMEROY AVE
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-1720
Mailing Address - Country:US
Mailing Address - Phone:785-421-3060
Mailing Address - Fax:
Practice Address - Street 1:308 N POMEROY AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-1720
Practice Address - Country:US
Practice Address - Phone:785-421-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist