Provider Demographics
NPI:1578120978
Name:SECORY, JON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:SECORY
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 1:20 S. 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428
Mailing Address - Country:US
Mailing Address - Phone:641-357-2169
Mailing Address - Fax:641-357-2156
Practice Address - Street 1:20 S. 4TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428
Practice Address - Country:US
Practice Address - Phone:641-357-2169
Practice Address - Fax:641-357-2156
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA145911835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric