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General NPI Number Information
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NPI Number | 1154035939
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Entity Type | Organization
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Legal Business Name | FAIRVIEW PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 404 HIGHWAY 96 W
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City | SHOREVIEW
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State | MN
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Zip | 55126-1900
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Country | US
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Telephone | 651-483-8283
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Fax | 651-483-8299
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Provider Business Mailing Address
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Address Line | 711 KASOTA AVE SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | SAMEER BADLANI
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Credential |
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Telephone | 612-617-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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