Healthcare Provider Details

I. General information

NPI: 1548344294
Provider Name (Legal Business Name): FAIRVIEW HEALTH SERVCIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S
EDINA MN
55435-2104
US

IV. Provider business mailing address

NW 7429 PO BOX 1450
MINNEAPOLIS MN
55485-7429
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-5160
  • Fax: 612-924-1304
Mailing address:
  • Phone: 612-672-5139
  • Fax: 612-672-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number261547
License Number StateMN

VIII. Authorized Official

Name: ROBERT BEACHER
Title or Position: PRESIDENT
Credential:
Phone: 612-672-7047