Provider Demographics
NPI:1427195684
Name:MCGOODWIN, PHYLLIS LEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LEE
Last Name:MCGOODWIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:LEE
Other - Last Name:MCGOODWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:10101 THOMPKINS PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5325
Mailing Address - Country:US
Mailing Address - Phone:405-271-5062
Mailing Address - Fax:405-271-1816
Practice Address - Street 1:940 NE 13TH ST
Practice Address - Street 2:ROOM 3510
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-5062
Practice Address - Fax:405-271-1816
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy