Provider Demographics
NPI:1497996490
Name:TOLSTEDT, SEAN CHRISTAIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CHRISTAIN
Last Name:TOLSTEDT
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 1:4405 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2350
Mailing Address - Country:US
Mailing Address - Phone:402-571-3122
Mailing Address - Fax:402-571-7117
Practice Address - Street 1:4405 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-2350
Practice Address - Country:US
Practice Address - Phone:402-571-3122
Practice Address - Fax:402-571-7117
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14742183500000X
NE11863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist