Healthcare Provider Details

I. General information

NPI: 1184538043
Provider Name (Legal Business Name): LESLIE C GOHAGAN I RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 OVERHILL RD
OPP AL
36467-1726
US

IV. Provider business mailing address

304 OVERHILL RD
OPP AL
36467-1726
US

V. Phone/Fax

Practice location:
  • Phone: 334-504-1143
  • Fax:
Mailing address:
  • Phone: 334-504-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12870
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: