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General NPI Number Information
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NPI Number | 1922722818
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Entity Type | Individual
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Provider Name | DOMINIQUE LEON WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 17850 N PENNSYLVANIA AVE
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City | EDMOND
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State | OK
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Zip | 73012-9101
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Country | US
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Telephone | 405-341-1142
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Fax |
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Provider Business Mailing Address
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Address Line | 16925 SUNNY HOLLOW RD
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City | EDMOND
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State | OK
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Zip | 73012-6740
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Country | US
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Telephone | 405-630-9502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19847
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License Number State | OK
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