MEDICARE: GERALD J SEDLACEK RPH

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	10548	KS

General Provider Information

NPI Number	:	1578141370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD J SEDLACEK RPH

Provider Business Mailing Address
First Line	:	1049 MINK RD
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-6109
Country	:	US
Telephone Number	:	620-625-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 W RUTLEDGE ST
Second Line	:
City	:	YATES CENTER
State	:	KS
Zip	:	66783-1238
Country	:	US
Telephone Number	:	620-625-2221
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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