Healthcare Provider Details

I. General information

NPI: 1962928358
Provider Name (Legal Business Name): WILLIAMS FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E SHAWNTEL SMITH BLVD
MULDROW OK
74948-4830
US

IV. Provider business mailing address

PO BOX 1109
MULDROW OK
74948-1109
US

V. Phone/Fax

Practice location:
  • Phone: 918-427-3242
  • Fax:
Mailing address:
  • Phone: 918-427-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number34-8004
License Number StateOK

VIII. Authorized Official

Name: DR. DEIDRA WILLIAMS
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 918-427-3243