MEDICARE: GOODRICH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	262083	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265084	OTHER	MN	MN BOARD OF PHARMACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2048253	OTHER		PK

General Provider Information

NPI Number	:	1891706305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODRICH PHARMACY INC

Provider Business Mailing Address
First Line	:	2621 GREENHAVEN RD STE 1
Second Line	:
City	:	ANOKA
State	:	MN
Zip	:	55303-5566
Country	:	US
Telephone Number	:	763-753-0222
Fax Number	:	763-753-3994

Provider Business Practice Location Address
First Line	:	23122 SAINT FRANCIS BLVD NW
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-9807
Country	:	US
Telephone Number	:	763-753-0222
Fax Number	:	763-753-3994

Authorized Official
Title or Position	:	CEO
Name	:	STEVE SIMENSON
Credential	:	PHARMD
Telephone Number	:	763-421-5540

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/06/2023

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Directions to “GOODRICH PHARMACY INC ” Practice Location

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