Healthcare Provider Details

I. General information

NPI: 1891250031
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/07/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SLOAN PL STE 35
SAINT PAUL MN
55117-2092
US

IV. Provider business mailing address

711 KASOTA AVE SE
MINNEAPOLIS MN
55414-2842
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-7005
  • Fax: 612-672-7320
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