Organization Active NPI

LK Goodson Inc

Doing business as City Drug of Coweta

  • Community/Retail Pharmacy
  • Coweta, OK
National Provider Identifier
1326074469
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
38-5215 Issued in OK
Legal business name
LK GOODSON INC
Doing business as
City Drug of Coweta
Practice address
114 N Broadway
Coweta, OK 74429-2600
Phone
(918) 486-2193
Fax
(918) 486-5313
NPI assigned
Jun 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Authorized official

Name
Lance GoodsonNPI 1194867556
Title
Owner
Phone
(918) 486-2193

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 38-5215 OK Primary

Addresses

Primary practice location

114 N Broadway
Coweta, OK 74429-2600

Mailing address

114 N Broadway
Coweta, OK 74429-2600
Phone (918) 486-2193

Other identifiers 2

IdentifierTypeStateIssuer
200119480AMedicaidOK
2072714OtherPK

Other names 1

  • CITY DRUG OF COWETA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930046098 OK DME Supplier - Pharmacy 1052517778 Practice locations: Coweta, OK
O20170828004258 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1052517778 Practice locations: Coweta, OK

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
City Drug of Coweta114 N Broadway, Coweta, OK 74429-2600(918) 486-2193 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Sep 27, 2007

National Provider Directory

National Provider Directory

Locations

114 N Broadway
Coweta, OK 74429
Phone (918) 486-2193

Practitioners & affiliated clinicians

Practitioners 2

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": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1326074469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 N BROADWAY",
            "city": "COWETA",
            "state": "OK",
            "postal_code": "744292600",
            "telephone_number": "918-486-2193",
            "fax_number": "918-486-5313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N BROADWAY",
            "city": "COWETA",
            "state": "OK",
            "postal_code": "744292600",
            "telephone_number": "918-486-2193",
            "fax_number": "918-486-5313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LK GOODSON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "GOODSON",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-486-2193"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "38-5215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200119480A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2072714",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITY DRUG OF COWETA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coweta, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.