MEDICARE: SEYBRIDGE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	1292	CT

General Provider Information

NPI Number	:	1932627593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEYBRIDGE PHARMACY INC

Provider Business Mailing Address
First Line	:	37 NEW HAVEN RD
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3460
Country	:	US
Telephone Number	:	203-888-0073
Fax Number	:	203-888-2932

Provider Business Practice Location Address
First Line	:	37 NEW HAVEN RD
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3460
Country	:	US
Telephone Number	:	203-888-0073
Fax Number	:	203-888-2932

Authorized Official
Title or Position	:	MANAGER
Name	:	LUIS VILLEGAS
Credential	:
Telephone Number	:	203-888-0073

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	03/07/2025

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