Organization
FAIRVIEW HEALTH SERVCIES
Active
Other names
UMMC FAIRVIEW RIVERSIDE CAMPUS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FASCHING (CFO)
(612) 672-6601
Entity
Organization
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 672-4200
(612) 672-4076
Mailing address
NW 7429, PO BOX 1450, MINNEAPOLIS, MN 55485-7429
(612) 672-5139
(612) 672-6545
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2045643
PK
—
01
—
260947
PHARMACY LICENSE
MN
05
—
380963300
—
MN
Enumeration date
10/25/2006
Last updated
12/13/2024
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