Healthcare Provider Details

I. General information

NPI: 1700109808
Provider Name (Legal Business Name): JOSEPH SAMBORSKI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 REYNOLDS ST
DANIELSON CT
06239-2917
US

IV. Provider business mailing address

42 REYNOLDS ST
DANIELSON CT
06239-2917
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-3214
  • Fax:
Mailing address:
  • Phone: 860-774-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3368
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier004169927
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: