Organization
HOMETOWN IGA PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE F GOODMAN DR (PHARMACY MANAGER)
(405) 424-4361
Entity
Organization
Contact information
Practice address
2001 NE 23RD, OKLAHOMA CITY, OK 73111
(405) 424-4361
(405) 424-4362
Mailing address
2001 NE 23RD, OKLAHOMA CITY, OK 73111
(405) 424-4361
(405) 424-4362
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9854
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3715200
PHARMACY
OK
Enumeration date
05/09/2007
Last updated
06/19/2008
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