Licensee Name:FAIRVIEW IDS PHARMACY
License Type:NONRESIDENT STERILE COMPOUNDING
License Number:99383
License Status:CANCELLED Definition
Expiration Date:November 01, 2012
Issue Date:November 14, 2006
Address:420 DELAWARE ST SE RM C 265 MAYO
City:MINNEAPOLIS
State:MN
Zip:55455
County:OUT OF STATE
Actions:No
NumberNameTypeStatus
754FAIRVIEW IDS PHARMACYNON RESIDENT PHARMACY CANCELLED

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