Organization
GOODRICH PHARMACY INC
Active
Other names
Goodrich Pharmacy Inc, Goodrich Pharmacy, Goodrich Clinical Services
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN THOMAS SIMENSON RPH (PRESIDENT)
(763) 421-5540
Entity
Organization
Contact information
Practice address
2621 GREENHAVEN RD STE 1, ANOKA, MN 55303-5566
(763) 421-5540
(763) 421-9229
Mailing address
2621 GREENHAVEN RD STE 1, ANOKA, MN 55303-5566
(763) 421-5540
(763) 421-9229
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Z008330
MN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0548820001
PTAN
—
01
—
24D0914028
CLIA
—
05
—
571358700
—
MN
Enumeration date
06/09/2005
Last updated
07/06/2023
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