Provider Demographics
NPI:1629360417
Name:HALBERT, SANDRA ELLEN
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELLEN
Last Name:HALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1592
Mailing Address - Country:US
Mailing Address - Phone:203-881-3123
Mailing Address - Fax:
Practice Address - Street 1:1 PADANARAM RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4836
Practice Address - Country:US
Practice Address - Phone:203-748-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist