Active NPI
Bob Elmer Goetz, RPH
- Pharmacist
- Red Wing, MN
National Provider Identifier
1114924198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 111549-9
- Practice address
- 401 West 3Rd St.
Red Wing, MN 55066-4022 - Phone
- (651) 388-4109
- NPI assigned
- Jul 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 111549-9 | MN | Primary |
Addresses
Primary practice location
401 West 3Rd St.
Red Wing, MN 55066-4022
Mailing address
2495 Wildwood RDG
Red Wing, MN 55066-4022
Phone (651) 388-4109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111549-9 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1114924198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2495 WILDWOOD RDG",
"city": "RED WING",
"state": "MN",
"postal_code": "550664022",
"telephone_number": "651-388-4109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 WEST 3RD ST.",
"city": "RED WING",
"state": "MN",
"postal_code": "550664022",
"telephone_number": "651-388-4109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZ",
"first_name": "BOB",
"middle_name": "ELMER",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-05",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "111549-9",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.