MEDICARE: FAIRVIEW PHARMACY SERVICES 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	3336C0003X	Community/Retail Pharmacy	262531	MN
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336S0011X	Specialty Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2048086	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508890450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	NW 7849
Second Line	:	PO BOX 1450
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-7849
Country	:	US
Telephone Number	:	612-617-3812
Fax Number	:	612-672-6659

Provider Business Practice Location Address
First Line	:	3650 VICTORIA ST N
Second Line	:	STE 600
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-2906
Country	:	US
Telephone Number	:	612-672-2233
Fax Number	:	612-672-2234

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/07/2025

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Directions to “FAIRVIEW PHARMACY SERVICES LLC ” Practice Location

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