Healthcare Provider Details

I. General information

NPI: 1437820818
Provider Name (Legal Business Name): SEBASTIAN STEVE GABRIEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 STONY BROOK DR
LOUISVILLE KY
40220-4018
US

IV. Provider business mailing address

1006 GLENRIDGE DR
LOUISVILLE KY
40242-3777
US

V. Phone/Fax

Practice location:
  • Phone: 502-493-8719
  • Fax:
Mailing address:
  • Phone: 859-691-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022601
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberI13788
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: