Provider Demographics
NPI:1285514521
Name:BRASTAD, SIDNEY (PHARMD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BRASTAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 ZENITH AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2609
Mailing Address - Country:US
Mailing Address - Phone:952-465-8135
Mailing Address - Fax:
Practice Address - Street 1:8251 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7610
Practice Address - Country:US
Practice Address - Phone:952-941-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist