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General NPI Number Information
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NPI Number | 1346244274
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Entity Type | Organization
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Legal Business Name | GOODRICH PHARMACY INC
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 2621 GREENHAVEN RD STE 1
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City | ANOKA
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State | MN
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Zip | 55303-5566
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Country | US
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Telephone | 763-421-5540
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Fax | 763-421-9229
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Provider Business Mailing Address
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Address Line | 2621 GREENHAVEN RD STE 1
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City | ANOKA
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State | MN
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Zip | 55303-5566
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Country | US
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Telephone | 763-421-5540
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Fax | 763-421-9229
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN THOMAS SIMENSON
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Credential | RPH
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Telephone | 763-421-5540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | Z008330
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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