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General NPI Number Information
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NPI Number | 1760792691
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Entity Type | Organization
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Legal Business Name | GOODRICH PHARMACY FRIDLEY
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 480 OSBORNE RD SUITE 180
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City | FRIDLEY
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State | MN
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Zip | 55432
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Country | US
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Telephone | 763-780-0222
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Fax | 763-208-1545
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Provider Business Mailing Address
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Address Line | 480 OSBORNE RD SUITE 180
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City | FRIDLEY
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State | MN
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Zip | 55432
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Country | US
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Telephone | 763-717-0222
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Fax | 763-208-1545
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT MICHAEL BENSON
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Credential | RPH
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Telephone | 763-717-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 263598
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License Number State | MN
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