Provider First Line Business Practice Location Address: 
6500 EXCELSIOR BLVD
    Provider Second Line Business Practice Location Address: 
METHODIST HOSPITAL INPATIENT PHARMACY
    Provider Business Practice Location Address City Name: 
ST LOUIS PARK
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55426-4702
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
612-993-5442
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/23/2007