Healthcare Provider Details

I. General information

NPI: 1043725260
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT JOHNS BLVD STE 101
MAPLEWOOD MN
55109-1190
US

IV. Provider business mailing address

PO BOX 9372
MINNEAPOLIS MN
55440-9372
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-5354
  • Fax: 612-672-7320
Mailing address:
  • Phone: 651-232-5354
  • Fax: 612-672-7320

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