=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689517617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOODRICH PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2026
-----------------------------------------------------
Last Update Date | 04/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 GREENHAVEN RD STE 1
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-421-5540
-----------------------------------------------------
Fax | 763-421-9229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 GREENHAVEN RD STE 1
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-421-5540
-----------------------------------------------------
Fax | 763-421-9229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | STEPHANIE MARIE DAVIS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 763-421-5540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------