Provider Demographics
NPI:1700109808
Name:SAMBORSKI, JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SAMBORSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2917
Mailing Address - Country:US
Mailing Address - Phone:860-774-3214
Mailing Address - Fax:
Practice Address - Street 1:42 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2917
Practice Address - Country:US
Practice Address - Phone:860-774-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004169927Medicaid
CT004169927Medicaid