Provider Demographics
NPI:1538455100
Name:SEBASTIAN, SIBY (BPHARM)
Entity type:Individual
Prefix:MR
First Name:SIBY
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NEWTOWN RD
Mailing Address - Street 2:APT A 14
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6256
Mailing Address - Country:US
Mailing Address - Phone:203-297-3483
Mailing Address - Fax:
Practice Address - Street 1:1387 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8159
Practice Address - Country:US
Practice Address - Phone:203-874-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist