Healthcare Provider Details

I. General information

NPI: 1972259570
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 MAYFAIR AVE
3605 MAYFAIR AVE MN
55746-2935
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-3441
  • Fax: 218-362-6170
Mailing address:
  • Phone: 218-262-3441
  • Fax: 218-362-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SAMEER BADLANI
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 612-617-3799