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General NPI Number Information
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NPI Number | 1902603228
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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 | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 600 W 98TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-4773
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Country | US
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Telephone | 951-881-2651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1450 NW 7429
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City | MINNEAPOLIS
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State | MN
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Zip | 55485-0001
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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 | AUTHORIZED OFFICIAL
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Name | SAMEER BADLANI
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Credential |
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Telephone | 612-672-6062
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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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