Healthcare Provider Details

I. General information

NPI: 1699832378
Provider Name (Legal Business Name): PHYLLIS M WILLIAMS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 E CHESTNUT ST
HOLLIS OK
73550-2031
US

IV. Provider business mailing address

1224 N 7TH ST P O BOX 708
HOLLIS OK
73550-1412
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2257
  • Fax:
Mailing address:
  • Phone: 580-688-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8398
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: