| NPI | 1790717783 |
|---|---|
| Doing Business As | FAIRVIEW LAKES PHARMACY WYOMING |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MN 262536) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-04-11 |