FAIRVIEW HIAWATHA PHARMACY MTM (NPI# 1851436539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851436539 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW HIAWATHA PHARMACY MTM |
| Practice Address |
3809 42nd Ave S Minneapolis MN 55406-3503 |
| Mailing Address |
Po Box 1450 Nw7429 Attn Contracting Minneapolis MN 55485-7429 |
| Practice Telephone | 6127287180 |
| Practice Fax Number | 6127287181 |
| Mailing Telephone | 6126725174 |
| Mailing Fax Number | 6126726659 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | STEVEN KIMMEL (CONTRACT MANAGER) |
| Authorized Official Telephone | 6126725302 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 2625292 | MN | Suppliers |
| Street Address |
3809 42ND AVE S |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55406-3503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972579670 | Angela Dhruvan | Family Medicine | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2006-02-23 |
| 1124438734 | Marissa Drake | Registered Nurse | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2014-05-05 |
| 1689010357 | Jodi Lynn Johnson | Registered Nurse | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2013-05-21 |
| 1780942078 | Deqa Yassin Mohamed | Family Medicine | 3809 42nd Ave S, Minneapolis, MN 55406 | 2012-04-25 |
| 1093005498 | Gennadiy Vasilyevich Shevchenko | Psychiatry & Neurology | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2011-04-19 |
| 1538492103 | Jennifer Lynn Nickell | Pharmacist | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2009-09-14 |
| 1598921108 | Katharine Jones Plosser | Physician Assistant | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2008-08-03 |
| 1922271857 | Sandeep Kalola | Family Medicine | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2008-04-11 |
| 1346432218 | Fairview Clinics | Clinic/Center | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2007-08-15 |
| 1932328226 | Louisa Paul | Family Medicine | 3809 42nd Ave S, Minneapolis, MN 55406-3503 | 2007-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689286221 | Hoa Bui | Pharmacist | 4547 Hiawatha, Minneapolis, MN 55406 | 2020-08-17 |
| 1184263253 | Carrie Shannon Nightshade | Acupuncturist | 3706 E 42nd Street, Minneapolis, MN 55406 | 2020-01-06 |
| 1164060059 | Deborah Owen | Acupuncturist | 3706 E 42nd St, Minneapolis, MN 55406 | 2019-12-11 |
| 1194290593 | Noelle Therese Wolf | Counselor | 2637 27th Ave S # 229, Minneapolis, MN 55406 | 2018-10-11 |
| 1255819819 | Ayan Osman Ali | Behavior Technician | 3355 Haiwatha Ave Suite 100, Minneapolis, MN 55406 | 2018-08-04 |
| 1881188597 | Lydia Joy Allison | Massage Therapist | 2933 29th Ave. S., Minneapolis, MN 55406 | 2018-06-15 |
| 1497261770 | Carroll Lee Beaty | Massage Therapist | 2801 42nd Ave. So., Minneapolis, MN 55406 | 2017-12-21 |
| 1578082798 | Capitol Cafe LLC | Home Delivered Meals | 2417 E Franklin Ave, Capitol Cafe, Minneapolis, MN 55406 | 2017-09-19 |
| 1851823942 | Safia Abdulkadir Mohamud | Contractor | 2740 Minnehaha Ave Suit 100, Minneapolis, MN 55406 | 2017-03-29 |
| 1881051944 | Sos Transportation LLC | Non-emergency Medical Transport (VAN) | 3355 Haiwatha Ave Suit 100, Minneapolis, MN 55406 | 2016-01-20 |
| Find all providers in zip 55406 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992148845 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 2450 Riverside Ave South, Minneapolis, MN 55454-1400 | 2013-04-10 |
| 1215152863 | Fairview Medication Therapy Management | Non-Pharmacy Dispensing Site | 606 24th Ave So., Suite 222, Riverside Professional Building, Minneapolis, MN 55454 | 2007-04-16 |
| 1760527030 | Fairview Northeast Pharmacy Mtm | Non-Pharmacy Dispensing Site | 2847 Johnson St Ne, Minneapolis, MN 55418-3055 | 2007-02-21 |
| 1659937944 | Fairview Pharmacy Service LLC | Non-Pharmacy Dispensing Site | 2020 E 28th St, Minneapolis, MN 55407-1394 | 2019-05-13 |
| 1972966281 | Fairview Pharmacy Services | Non-Pharmacy Dispensing Site | 2512 S 7th St Fl 3, Minneapolis, MN 55454-1404 | 2016-04-04 |
| 1861855173 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 909 Fulton St Se, 3rd Floor Clinic and Surgery Center, Minneapolis, MN 55455-4800 | 2016-04-04 |
| 1093086837 | Group Health Plan Inc | Non-Pharmacy Dispensing Site | 8170 33rd Ave S, Mailstop 21111b, Minneapolis, MN 55425-4516 | 2012-01-25 |
| 1922390863 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 516 Delaware St Se, Clinic 6b, Minneapolis, MN 55455-0356 | 2011-05-11 |
| 1912204561 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 424 Harvard St Se, Suite 300, Mmc 114, Minneapolis, MN 55455-0362 | 2011-02-17 |
| 1477889814 | Fairview Pharmacy Services, LLC | Non-Pharmacy Dispensing Site | 516 Delaware St Se, First Floor, Clinic 1c, Minneapolis, MN 55455-0356 | 2009-10-20 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55406 |
Please comment or provide details below to improve the information on FAIRVIEW HIAWATHA PHARMACY MTM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.