| NPI | 1649531732 |
|---|---|
| Doing Business As | FAIRVIEW LAKES PHARMACY - WYOMING 340B |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MN 262536-0) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2023-04-12 |