Provider Demographics
NPI:1649070079
Name:WILLIAMS-WHITAKER, STEPHANIE K (DPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WILLIAMS-WHITAKER
Suffix:
Gender:
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5426
Mailing Address - Country:US
Mailing Address - Phone:918-426-5223
Mailing Address - Fax:
Practice Address - Street 1:622 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5426
Practice Address - Country:US
Practice Address - Phone:918-426-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist