Healthcare Provider Details

I. General information

NPI: 1750947040
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MARYLAND AVE E
SAINT PAUL MN
55106-2824
US

IV. Provider business mailing address

711 KASOTA AVE SE
MINNEAPOLIS MN
55414-2842
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-3461
  • Fax: 651-772-2605
Mailing address:
  • Phone: 612-672-5128
  • 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