Provider Demographics
NPI:1699832378
Name:WILLIAMS, PHYLLIS M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N 7TH ST
Mailing Address - Street 2:P O BOX 708
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-1412
Mailing Address - Country:US
Mailing Address - Phone:580-688-3668
Mailing Address - Fax:
Practice Address - Street 1:509 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2031
Practice Address - Country:US
Practice Address - Phone:580-688-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist