Healthcare Provider Details

I. General information

NPI: 1942104807
Provider Name (Legal Business Name): FAIRVIEW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WOODWINDS DR
WOODBURY MN
55125-4445
US

IV. Provider business mailing address

1925 WOODWINDS DR
WOODBURY MN
55125-4445
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-0200
  • Fax:
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 StateNULL

VIII. Authorized Official

Name: SAMEER BADLANI
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 612-672-6062