GOODRICH PHARMACY ANDOVER – Community/Retail Pharmacy, NPI 1619089612
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for GOODRICH PHARMACY ANDOVER
601, Jacob Lane, Anoka, Anoka County, Minnesota, 55303, United States
ANOKA, MN 553031776
Phone: (763) 421-4766
Fax: (763) 421-9229
Type: Mailing
15245, Bluebird Street Northwest, Andover, Anoka County, Minnesota, 55304, United States
STE B
ANDOVER, MN 55304
Phone: (763) 434-1901
Fax: (763) 587-4694
Type: Location
2621 GREENHAVEN RD STE 1
ANOKA, MN 553035566
Phone: (763) 421-4766
Fax: (763) 421-9229
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-03-31 (804 days ago).
Enrollment records
2
Earliest due date
2024-03-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031211000228 | O | Mass Immunization (Roster Biller Only) | MN | TBD |
| O20100930095052 | O | Pharmacy | MN | 2024-03-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90480 | Admn sarscov2 vacc 1 dose | 19 | 19 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 19 | 19 | $0 |
Insurance plans in this area (ZIP 55303)
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