Healthcare Provider Details

I. General information

NPI: 1396400396
Provider Name (Legal Business Name): SEAN ANSOLABEHERE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 FLORIDA AVE S
BLOOMINGTON MN
55438-2553
US

IV. Provider business mailing address

696 JUTLAND AVE
SHAKOPEE MN
55379-3176
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125454
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: