Provider Demographics
NPI:1508457607
Name:WILLIAMS, CHELSEA KYRSTIN MAMI (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KYRSTIN MAMI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ANN BRANDEN BLVD APT 233
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1501
Mailing Address - Country:US
Mailing Address - Phone:580-216-3210
Mailing Address - Fax:
Practice Address - Street 1:2551 CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-4381
Practice Address - Country:US
Practice Address - Phone:580-216-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist