Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Jon Heidorn, PHARMD

Individual provider Pharmacist · NPI 1710561386

Ethan Jon Heidorn, PHARMD is a Pharmacist in St Louis Park, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2021
What do these letters mean?
PHARMD — Doctor of Pharmacy
The professional degree required to practise as a pharmacist in the United States.

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Practice location Address checks out

3601 Highway 100 S
St Louis Park, MN 55416-2500
Phone: (952) 926-8967
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 124875 (MN)

Record details

NPI number1710561386
Entity typeIndividual (Type 1)
GenderMale
Credentials PHARMD
Sole proprietorYes
NPI enumeratedMay 10, 2021
Last updated in NPPESMay 10, 2021
Certification dateMay 10, 2021
Mailing address3601 Highway 100 S, St Louis Park, MN 55416-2500

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