NPIMap

Organization Active NPI

Goodrich Pharmacy Inc

  • Community/Retail Pharmacy
  • Saint Francis, MN
National Provider Identifier
1891706305
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
262083 Issued in MN
Legal business name
GOODRICH PHARMACY INC
Practice address
23122 Saint Francis Blvd NW
Saint Francis, MN 55070-9807
Phone
(763) 753-0222
Fax
(763) 753-3994
NPI assigned
Aug 10, 2006
Organization subpart
No

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
Steve Simenson, PHARMD
Title
Ceo
Phone
(763) 421-5540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 262083 MN Primary

Addresses

Primary practice location

23122 Saint Francis Blvd NW
Saint Francis, MN 55070-9807

Mailing address

2621 Greenhaven Rd Ste 1
Anoka, MN 55303-5566
Phone (763) 753-0222

Other identifiers 3

IdentifierTypeStateIssuer
265084OtherMNMN BOARD OF PHARMACY
181617900MedicaidMN
2048253OtherPK

Other names 1

  • GOODRICH PHARMACY ST FRANCIS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031211000228 MN Part B Supplier - Mass Immunization (Roster Biller Only) 4082510813 4 other NPIs on this enrollment
Practice locations: Saint Francis, MN; Elk River, MN; Andover, MN; Anoka, MN
O20100930079519 MN DME Supplier - Pharmacy 4082510813 Practice locations: Saint Francis, MN

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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 St Francis23122 Saint Francis Blvd, Saint Francis, MN 55070-9807(763) 753-0222 Blood Glucose Monitors/Supplies (Non-Mail Order)|Parenteral Nutrients|Parenteral Equipment and/or Supplies|Nebulizer Equipment and/or Supplies|Diabetic Shoes and Inserts Accepts assignmentParticipating since May 20, 2020

National Provider Directory

National Provider Directory
Tax ID family
Goodrich Pharmacy Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1891706305",
    "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": "763-753-0222",
            "fax_number": "763-753-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23122 SAINT FRANCIS BLVD NW",
            "city": "SAINT FRANCIS",
            "state": "MN",
            "postal_code": "550709807",
            "telephone_number": "763-753-0222",
            "fax_number": "763-753-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODRICH PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-07-06",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "SIMENSON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-421-5540",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BOARD OF PHARMACY",
            "identifier": "265084",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181617900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048253",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOODRICH PHARMACY ST FRANCIS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GOODRICH PHARMACY ST FRANCIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Francis, 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.