Organization
PARK NICOLLET METHODIST HOSPITAL
Active
Other names
Park Nicollet Home Infusion
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BUSCH (VP PHARMACY OPERATIONS)
(952) 967-5049
Entity
Organization
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5670
(952) 993-5354
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5670
(952) 993-5354
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
200304
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061250
—
WI
Enumeration date
02/08/2017
Last updated
02/09/2017
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