Provider Demographics
NPI:1093712390
Name:EKSTRAND, MOLLY JO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:JO
Last Name:EKSTRAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 EXCELSIOR BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4706
Mailing Address - Country:US
Mailing Address - Phone:952-993-2087
Mailing Address - Fax:952-993-1334
Practice Address - Street 1:6600 EXCELSIOR BLVD STE 151
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4706
Practice Address - Country:US
Practice Address - Phone:952-993-2087
Practice Address - Fax:952-993-1334
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116275-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist