Healthcare Provider Details

I. General information

NPI: 1538455100
Provider Name (Legal Business Name): SIBY SEBASTIAN B.PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 NEW HAVEN AVE
MILFORD CT
06460-8159
US

IV. Provider business mailing address

14 NEWTOWN RD APT A 14
DANBURY CT
06810-6256
US

V. Phone/Fax

Practice location:
  • Phone: 203-874-0845
  • Fax:
Mailing address:
  • Phone: 203-297-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0011204
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: