Provider Demographics
NPI:1346945524
Name:SENNE, SCOTT KENT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KENT
Last Name:SENNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32944 OASIS RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-9616
Mailing Address - Country:US
Mailing Address - Phone:952-334-8803
Mailing Address - Fax:
Practice Address - Street 1:11401 MARKETPLACE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3794
Practice Address - Country:US
Practice Address - Phone:763-427-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist