Provider Demographics
NPI:1750665337
Name:SEARS, JERALD
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:
Last Name:SEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ST HWY 165
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3464
Mailing Address - Country:US
Mailing Address - Phone:417-339-3996
Mailing Address - Fax:
Practice Address - Street 1:210 ST HWY 165
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3464
Practice Address - Country:US
Practice Address - Phone:417-339-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist