NPIMap

Organization Active NPI

Fairview Pharmacy Services LLC

  • Community/Retail Pharmacy
  • Maple Grove, MN
National Provider Identifier
1124228176
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
263036 Issued in MN
Legal business name
FAIRVIEW PHARMACY SERVICES LLC
Practice address
14500 99TH Ave N
1A029
Maple Grove, MN 55369-4730
Phone
(763) 898-1800
Fax
(763) 898-1801
NPI assigned
Jul 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 263036 MN Primary

Addresses

Primary practice location

14500 99TH Ave N
1A029
Maple Grove, MN 55369-4730

Mailing address

NW 7429
PO Box 1450
Minneapolis, MN 55485-7429
Phone (612) 672-5139

Other identifiers 2

IdentifierTypeStateIssuer
1124228176MedicaidMN
2049243OtherPK

Other names 1

  • FARIVIEW PHARMACY MAPLE GROVE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930087157 MN DME Supplier - Pharmacy 2961573084 Practice locations: Maple Grove, MN
O20200409000162 MN Part B Supplier - Mass Immunization (Roster Biller Only) 2961573084 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Maplewood, MN; Minneapolis, MN; New Brighton, MN; North Branch, MN; Princeton, MN; Prior Lake, MN; Rosemount, MN; Saint Paul, MN…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fairview Pharmacy Maple Grove14500 99TH Ave N, Maple Grove, MN 55369-4730(763) 898-1800 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Accepts assignmentParticipating since Jan 1, 2025

National Provider Directory

National Provider Directory

Locations

14500 99th Ave N
#1A29
Maple Grove, MN 55369
Phone (763) 898-1800

14500 99th Ave N
Ste 1A29
Maple Grove, MN 55369
Phone (763) 898-1800

14500 99th Ave N
Ste A29
Maple Grove, MN 55369

NW 7429
Minneapolis, MN 55485

NPI Registry JSON

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1124228176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NW 7429",
            "address_2": "PO BOX 1450",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554857429",
            "telephone_number": "612-672-5139",
            "fax_number": "612-672-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N",
            "address_2": "1A029",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694730",
            "telephone_number": "763-898-1800",
            "fax_number": "763-898-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124228176",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049243",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FARIVIEW PHARMACY MAPLE GROVE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FARIVIEW PHARMACY MAPLE GROVE",
            "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 Mar 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.