| Organization Name: | SAGE MEMORIAL HOSPITAL |
| NPI Number: | 1447315494 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FARID KIYARASH (DIR OF PHCY) |
| Mailing Address: | Hwy 264 And 191 Ganado |
| State: | AZ US |
| Postal Code: | 86505 |
| Phone Number: | 9287554500 |
| Fax Number: | 9287554659 |
| NPI Enumeration Date: | 12/27/2006 |
| NPI Last Update Date: | 06/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336M0003X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Managed Care Organization Pharmacy |
| Taxonomy Definition: | A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO |