NPIMap

Organization Active NPI

Goodrich Pharmacy, Inc.

Doing business as Goodrich Pharmacy LTC

  • Long Term Care Pharmacy
  • Anoka, MN
National Provider Identifier
1457937773
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
GOODRICH PHARMACY, INC.
Doing business as
Goodrich Pharmacy LTC
Practice address
2321 7TH Ave
Anoka, MN 55303-1790
Phone
(763) 421-5540
NPI assigned
Mar 18, 2021
Last updated
Jul 6, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GOODRICH PHARMACY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cory MiddendorfNPI 1598117467
Title
Pharmacist in Charge
Phone
(763) 421-5540

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

2321 7TH Ave
Anoka, MN 55303-1790

Mailing address

2621 Greenhaven Rd Ste 1
Anoka, MN 55303-5566
Phone (763) 421-5540

Other identifiers 1

IdentifierTypeStateIssuer
571358700MedicaidMN

Other names 1

  • Goodrich Pharmacy LTC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231018001580 MN DME Supplier - Pharmacy 4082510813 Practice locations: Anoka, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Goodrich Pharmacy LTC2321 7TH Ave, Anoka, MN 55303-1710(763) 294-9575 Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Accepts assignmentParticipating since May 20, 2020

National Provider Directory

National Provider Directory
Tax ID family
Goodrich Drug Co Inc6 organizations share this tax ID, including this one
Part of
Goodrich Drug Co Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15245 Bluebird St NW
Anoka, MN 55304
Phone (763) 587-4600

2321 7th Ave
Anoka, MN 55303
Phone (763) 427-7869

530 3rd St NW
Ste 102
Elk River, MN 55330
Phone (763) 441-0764

11855 Ulysses St NE
Minneapolis, MN 55434
Phone (763) 420-1010

23122 Saint Francis Blvd NW
Saint Francis, MN 55070
Phone (763) 753-0222

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1457937773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 GREENHAVEN RD STE 1",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553035566",
            "telephone_number": "763-421-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 7TH AVE",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553031790",
            "telephone_number": "763-421-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODRICH PHARMACY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOODRICH PHARMACY, INC.",
        "enumeration_date": "2021-03-18",
        "last_updated": "2023-07-06",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "MIDDENDORF",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "763-421-5540"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "571358700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodrich Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Goodrich Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anoka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.