Healthcare Provider Details

I. General information

NPI: 1952416125
Provider Name (Legal Business Name): SBS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 MAIN ST
WILLIMANTIC CT
06226-2310
US

IV. Provider business mailing address

972 MAIN ST
WILLIMANTIC CT
06226-2310
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-9600
  • Fax: 860-423-9601
Mailing address:
  • Phone: 860-423-9600
  • Fax: 860-423-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY0000070
License Number StateCT

VIII. Authorized Official

Name: BRAHMAJI GAZZARAPU
Title or Position: PHARMACY MANAGER
Credential:
Phone: 860-423-9600