Leslie Floyd Goodman
Individual provider Active NPI Pharmacist · Choctaw, OK
NPI 1053987123 · NPPES record last updated May 31, 2021
Key facts
- NPI
- 1053987123
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 9854 (OK)
- Practice address
- 2350 Harper St
Choctaw, OK 73020-8087 - Phone
- (405) 390-3670
- Fax
- (405) 390-3670
- NPI assigned
- May 31, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9854 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9854 | OK | Yes |
Addresses
Primary practice location
2350 Harper St
Choctaw, OK 73020-8087
Mailing address
2350 Harper St
Choctaw, OK 73020-8087
Phone (405) 390-3611
Other providers in Choctaw, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.