Healthcare Provider Details

I. General information

NPI: 1184723256
Provider Name (Legal Business Name): DR. GREGORY JOHN SEALOCK X
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST VA CENTRAL IOWA HEALTH CARE SYSTEM PHARMACY DEPARTMENT
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

500 EVANS BLVD
PLEASANT HILL IA
50327-1983
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5959
  • Fax: 515-699-5885
Mailing address:
  • Phone: 402-699-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number11947
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: