Healthcare Provider Details

I. General information

NPI: 1770494528
Provider Name (Legal Business Name): AMBER LYNN WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER DR
ADA OK
74820-3439
US

IV. Provider business mailing address

9640 S 369TH WEST AVE
MANNFORD OK
74044-6228
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-4579
  • Fax: 580-421-4540
Mailing address:
  • Phone: 918-808-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21495
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: