Provider Demographics
NPI:1184723256
Name:SEALOCK, GREGORY JOHN X
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:SEALOCK
Suffix:X
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 1:500 EVANS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-1983
Mailing Address - Country:US
Mailing Address - Phone:402-699-3275
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:VA CENTRAL IOWA HEALTH CARE SYSTEM PHARMACY DEPARTMENT
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5959
Practice Address - Fax:515-699-5885
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist