Healthcare Provider Details

I. General information

NPI: 1477889814
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE ST SE FIRST FLOOR, CLINIC 1C
MINNEAPOLIS MN
55455-0356
US

IV. Provider business mailing address

PO BOX 1450 NW5823
MINNEAPOLIS MN
55485-5823
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-3444
  • Fax: 612-625-5935
Mailing address:
  • Phone:
  • Fax:

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