Fairview Pharmacy Services LLC
Organization Active NPI Community/Retail Pharmacy · Wyoming, MN
NPI 1790717783 · NPPES record last updated Mar 12, 2025
Key facts
- NPI
- 1790717783
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 262536 (MN)
- Legal business name
- FAIRVIEW PHARMACY SERVICES LLC
- Practice address
- 5200 Fairview Blvd
Wyoming, MN 55092-8013 - Phone
- (651) 982-7500
- Fax
- (651) 982-7504
- NPI assigned
- Jul 7, 2006
- 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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930054561 | MN | DME Supplier - Pharmacy | 2961573084 | Practice locations: Wyoming, 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
711 Kasota Ave SE
#H
Minneapolis, MN 55414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | 262536 | MN | Yes |
Addresses
Primary practice location
5200 Fairview Blvd
Wyoming, MN 55092-8013
Mailing address
NW 7429
PO Box 1450
Minneapolis, MN 55485-7429
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 236142600 | Medicaid | MN | |
| 1790717783 | Medicaid | MN | |
| 2047842 | Other | PK |
Other names
- FAIRVIEW LAKES PHARMACY WYOMING
Other providers in Wyoming, MN
- Fairview Health Services
- Fairview Health Services
- Fairview Health SVC
- Fairview Pharmacy Services LLC
- Fairview Pharmacy Services LLC
- Fairview Pharmacy Services LLC
- Fallon Hagy
- Cynthia Marie Felegy
- Amber N Fluto
- Sarah Connaughty Fuerstenberg
All providers in Wyoming, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.