Provider Demographics
NPI:1588268692
Name:PATEL, SAGAR JAGDISHBHAI
Entity type:Individual
Prefix:
First Name:SAGAR
Middle Name:JAGDISHBHAI
Last Name:PATEL
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 1:105 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4701
Mailing Address - Country:US
Mailing Address - Phone:361-758-1404
Mailing Address - Fax:
Practice Address - Street 1:105 S AVENUE A
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4701
Practice Address - Country:US
Practice Address - Phone:361-758-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist