Provider Demographics
NPI:1194800466
Name:SAGEN, ROBERT MORRIS
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MORRIS
Last Name:SAGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 STATE ROUTE 105
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-9226
Mailing Address - Country:US
Mailing Address - Phone:360-942-3356
Mailing Address - Fax:
Practice Address - Street 1:515 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2509
Practice Address - Country:US
Practice Address - Phone:360-942-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00008063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00008063OtherWASH PHARMACIST LISCENCE