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General NPI Number Information
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NPI Number | 1184723256
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Entity Type | Individual
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Provider Name | DR. GREGORY JOHN SEALOCK X
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3600 30TH ST VA CENTRAL IOWA HEALTH CARE SYSTEM PHARMACY DEPARTMENT
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City | DES MOINES
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State | IA
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Zip | 50310-5753
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Country | US
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Telephone | 515-699-5959
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Fax | 515-699-5885
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Provider Business Mailing Address
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Address Line | 500 EVANS BLVD
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City | PLEASANT HILL
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State | IA
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Zip | 50327-1983
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Country | US
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Telephone | 402-699-3275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11947
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License Number State | NE
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