Healthcare Provider Details

I. General information

NPI: 1447545165
Provider Name (Legal Business Name): JOSEPH WALTER SEIBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 MAIN ST
STRATFORD CT
06614-4102
US

IV. Provider business mailing address

26 TRAM DR
OXFORD CT
06478-1827
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-8065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8018
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: