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General NPI Number Information
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NPI Number | 1770119265
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Entity Type | Individual
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Provider Name | COURTNEY IRENEE SANNES PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 4050 DEAN LAKES BLVD
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City | SHAKOPEE
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State | MN
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Zip | 55379-2714
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Country | US
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Telephone | 952-402-9039
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 COUNTRYSIDE DR
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City | SHAKOPEE
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State | MN
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Zip | 55379-4554
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Country | US
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Telephone | 605-310-1766
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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 | 120921
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License Number State | MN
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