Provider Demographics
NPI:1578640249
Name:WILLIAMS PHARMACY INC
Entity Type:Organization
Organization Name:WILLIAMS PHARMACY INC
Other - Org Name:WILLIAMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-527-5682
Mailing Address - Street 1:700 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73051-9067
Mailing Address - Country:US
Mailing Address - Phone:405-527-5682
Mailing Address - Fax:405-527-5683
Practice Address - Street 1:700 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OK
Practice Address - Zip Code:73051-9067
Practice Address - Country:US
Practice Address - Phone:405-527-5682
Practice Address - Fax:405-527-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7-52223336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100235140AMedicaid
2073468OtherPK