Provider Demographics
NPI:1851856769
Name:WILLIAMS, RYAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPANUCKA
Mailing Address - State:OK
Mailing Address - Zip Code:73461-1012
Mailing Address - Country:US
Mailing Address - Phone:580-364-4020
Mailing Address - Fax:580-924-0525
Practice Address - Street 1:1026 RADIO RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2991
Practice Address - Country:US
Practice Address - Phone:580-924-7425
Practice Address - Fax:580-924-0525
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist