Provider Demographics
NPI:1578141370
Name:SEDLACEK, GERALD J (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:SEDLACEK
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 1:1049 MINK RD
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-6109
Mailing Address - Country:US
Mailing Address - Phone:620-625-2221
Mailing Address - Fax:
Practice Address - Street 1:122 W RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1238
Practice Address - Country:US
Practice Address - Phone:620-625-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist