Provider Demographics
NPI:1487985321
Name:SEDENKA, SHANE THOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:THOMAS
Last Name:SEDENKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-7609
Mailing Address - Country:US
Mailing Address - Phone:319-270-1040
Mailing Address - Fax:
Practice Address - Street 1:2949 SIERRA CT SW
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8503
Practice Address - Country:US
Practice Address - Phone:319-688-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist