Provider Demographics
NPI:1952984882
Name:SAGAMORE RX INC.
Entity Type:Organization
Organization Name:SAGAMORE RX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN NAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-467-0661
Mailing Address - Street 1:3712 PASEO PRIMARIO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3054
Mailing Address - Country:US
Mailing Address - Phone:310-467-0661
Mailing Address - Fax:
Practice Address - Street 1:20944 SHERMAN WAY STE 203
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3636
Practice Address - Country:US
Practice Address - Phone:310-467-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies