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
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy	262526	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048483	OTHER		PK

General Provider Information

NPI Number	:	1629241732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	NW 7429
Second Line	:	PO BOX 1450
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-7429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 VICTORIA ST N
Second Line	:	STE 500
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-2906
Country	:	US
Telephone Number	:	612-672-5737
Fax Number	:	612-672-5738

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

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	10/10/2025

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