Provider Demographics
NPI:1982207015
Name:SAGAN, STANLEY ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ROBERT
Last Name:SAGAN
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 1:1 MCWHIRT LOOP
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1082
Mailing Address - Country:US
Mailing Address - Phone:540-371-2627
Mailing Address - Fax:
Practice Address - Street 1:1 MCWHIRT LOOP
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1082
Practice Address - Country:US
Practice Address - Phone:540-371-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE