Healthcare Provider Details

I. General information

NPI: 1093919482
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 VICTORIA ST N STE 300
SHOREVIEW MN
55126-2906
US

IV. Provider business mailing address

PO BOX 1450 NW7429
MINNEAPOLIS MN
55414
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-5260
  • Fax: 612-672-5330
Mailing address:
  • Phone: 612-672-5302
  • Fax: 612-672-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2625425
License Number StateMN

VIII. Authorized Official

Name: SAMEER BADLANI
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 612-617-3799