MEDICARE: GERO GABA SEDEDJI PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202215474	VA
2	183500000X	Pharmacist	26028021A	IN
3	183500000X	Pharmacist	57437	TX
4	183500000X	Pharmacist	PH100002488	DC

General Provider Information

NPI Number	:	1790223998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERO GABA SEDEDJI PHARM.D

Provider Business Mailing Address
First Line	:	2920 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218
Country	:	US
Telephone Number	:	317-545-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1518
Country	:	US
Telephone Number	:	317-545-6167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	06/30/2023

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