Fairview Pharmacy Services LLC
Organization Active NPI Community/Retail Pharmacy · Chisago City, MN
NPI 1245636489 · NPPES record last updated Mar 12, 2025
Key facts
- NPI
- 1245636489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 264593 (MN)
- Legal business name
- FAIRVIEW PHARMACY SERVICES LLC
- Practice address
- 11725 Stinson Ave BLDG B
Chisago City, MN 55013-9542 - Phone
- (651) 213-8080
- Fax
- (651) 213-8081
- NPI assigned
- Nov 17, 2014
- Organization subpart
- No
Authorized official
- Name
- Sameer Badlani
- Title
- Chairman of the Board
- Phone
- (612) 617-3799
Other NPIs on the same Medicare enrollment 23
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Fairview Pharmacy Chisago City |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150216000308 | MN | DME Supplier - Pharmacy | 2961573084 | Practice locations: Chisago City, 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… |
National Provider Directory
Locations
11725 Stinson Ave
Bldg B
Chisago City, MN 55013
Phone (651) 213-8080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | 264593 | MN | Yes |
Addresses
Primary practice location
11725 Stinson Ave BLDG B
Chisago City, MN 55013-9542
Mailing address
NW 7429
PO Box 1450
Minneapolis, MN 55485-7429
Phone (612) 672-5139
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2148755 | Other | PK |
Other names
- Fairview Pharmacy Chisago City
Other providers in Chisago City, MN
- Ecumen
- Ecumen
- Elan Acupuncture LLC
- Lynn Marie Fagen Moore
- Fairview Clinics
- Family Based Therapy Associates
- Susan Flannigan
- Charles Michael Gramling
- Gregory Contracting Inc.
- Thomas Paul Gustafson
All providers in Chisago City, MN · Community/Retail Pharmacy in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.