MEDICARE: FAIRVIEW PHARMACY SERVICES, LLC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1477889806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW PHARMACY SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1450 NW5823
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-5823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15075 CIMARRON AVE
Second Line	:
City	:	ROSEMOUNT
State	:	MN
Zip	:	55068-1635
Country	:	US
Telephone Number	:	651-322-8800
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	SAMEER BADLANI
Credential	:
Telephone Number	:	612-617-3799

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	03/12/2025

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