MEDICARE: MRS. MOLLY JO EKSTRAND R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	116275-6	MN

General Provider Information

NPI Number	:	1093712390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLY JO EKSTRAND R.PH.

Provider Business Mailing Address
First Line	:	6600 EXCELSIOR BLVD STE 151
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-4706
Country	:	US
Telephone Number	:	952-993-2087
Fax Number	:	952-993-1334

Provider Business Practice Location Address
First Line	:	6600 EXCELSIOR BLVD STE 151
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-4706
Country	:	US
Telephone Number	:	952-993-2087
Fax Number	:	952-993-1334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/14/2014

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