MEDICARE: FAIRVIEW PHARMACY SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1316461593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW PHARMACY SERVICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 7412164
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2164
Country	:	US
Telephone Number	:	952-831-1551
Fax Number	:	952-831-0725

Provider Business Practice Location Address
First Line	:	7600 FRANCE AVE S
Second Line	:	STE 4100
City	:	EDINA
State	:	MN
Zip	:	55435-6027
Country	:	US
Telephone Number	:	952-831-1551
Fax Number	:	952-831-0725

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	SAMEER BADLANI
Credential	:
Telephone Number	:	612-617-3799

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	06/01/2026

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