Provider Demographics
NPI:1194312314
Name:SEDUSHAK, CLAIRE M
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:M
Last Name:SEDUSHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3227
Mailing Address - Country:US
Mailing Address - Phone:414-672-4554
Mailing Address - Fax:
Practice Address - Street 1:1316 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3227
Practice Address - Country:US
Practice Address - Phone:414-672-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9517-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist