Healthcare Provider Details

I. General information

NPI: 1972535953
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PARKWAY SUITE 130
ST. PAUL MN
55116-3409
US

IV. Provider business mailing address

NW 7429 PO BOX 1450
MINNEAPOLIS MN
55485-7429
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-5020
  • Fax: 691-696-5025
Mailing address:
  • Phone: 612-672-5139
  • Fax: 612-672-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262530
License Number StateMN

VIII. Authorized Official

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