GOODRICH PHARMACY INC. NPI 1174635171

NPI Information

  • NPI: 1174635171
  • Provider Name: GOODRICH PHARMACY, INC.
  • Classification: Pharmacy - 3336C0002X
  • Specialization: Clinic Pharmacy
  • Entity Type: Organization
  • Doing Business As: GOODRICH PHARMACY ELK RIVER
  • CLIA Number: 24D2183636
  • Address: 530 3RD ST NW
    ELK RIVER, MN
    ZIP 55330
  • Phone: (763) 441-0764

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NPI Details

GOODRICH PHARMACY, INC. is a clinic pharmacy pharmacy in Elk River, MN. The provider is a pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. GOODRICH PHARMACY, INC. NPI is 1174635171. The provider is registered as an organization entity type.
The provider Is Doing Business As Goodrich Pharmacy Elk River.

The provider's business location address is:

530 3RD ST NW
ELK RIVER, MN
ZIP 55330-445
Phone: (763) 441-0764
Fax: (763) 587-4897

The provider's authorized official is Stephanie Marie Davis .
The authorized official title is Owner and has the following contact phone number (763) 421-5540.

The CLIA number assigned to this NPI record is 24D2183636 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
  • Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
  • Fee covid-19 vac 14 res (HCPCS:0134A)
  • Fee covid-19 vac 13 res (HCPCS:0124A)
  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)

The enumeration date for this NPI number is 8/31/2006 and was last updated on 7/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail PharmacyNo
33336C0002XPharmacyClinic Pharmacy265080MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12046716OTHERPK
2606360800MEDICAIDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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