Provider Demographics
NPI:1790223998
Name:SEDEDJI, GERO GABA (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERO
Middle Name:GABA
Last Name:SEDEDJI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218
Mailing Address - Country:US
Mailing Address - Phone:317-545-6167
Mailing Address - Fax:
Practice Address - Street 1:2920 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-1518
Practice Address - Country:US
Practice Address - Phone:317-545-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215474183500000X
IN26028021A183500000X
TX57437183500000X
DCPH100002488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist