NPIMap

Organization Active NPI

Fairview Pharmacy Services LLC

Doing business as Fairview Maple Grove Clinic MTM

  • Non-Pharmacy Dispensing Site
  • Maple Grove, MN
National Provider Identifier
1063615979
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
APPLIED Issued in MN
Legal business name
FAIRVIEW PHARMACY SERVICES LLC
Doing business as
Fairview Maple Grove Clinic MTM
Practice address
14500 99TH Ave N
Maple Grove, MN 55369-4730
Phone
(763) 898-1000
Fax
(763) 898-1801
NPI assigned
Jun 7, 2007
Last updated
Jul 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sameer Badlani
Title
Chairman of the Board
Phone
(612) 617-3799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X APPLIED MN Primary

Addresses

Primary practice location

14500 99TH Ave N
Maple Grove, MN 55369-4730

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (763) 898-1000

Other names 1

  • Fairview Maple Grove Clinic MTM Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fairview Phamacy SVCS LLC67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

14500 99th Ave N
Ste 1C1
Maple Grove, MN 55369

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1063615979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727",
            "telephone_number": "763-898-1000",
            "fax_number": "763-898-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694730",
            "telephone_number": "763-898-1000",
            "fax_number": "763-898-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A",
        "authorized_official_last_name": "BADLANI",
        "authorized_official_first_name": "SAMEER",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "612-617-3799"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "MN",
            "license": "APPLIED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview Maple Grove Clinic MTM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.