Provider Demographics
NPI:1790073203
Name:SEDLACKO, THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:SEDLACKO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WILSON AVENUE
Mailing Address - Street 2:T-2567
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-634-3141
Mailing Address - Fax:717-634-3141
Practice Address - Street 1:31 WILSON AVENUE
Practice Address - Street 2:T-2567
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-634-3141
Practice Address - Fax:717-634-3141
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist