Provider Demographics
NPI:1063796142
Name:WILLIAMS, KRISTIN A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:2100 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1506
Mailing Address - Country:US
Mailing Address - Phone:405-842-0745
Mailing Address - Fax:405-842-6546
Practice Address - Street 1:2100 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-1506
Practice Address - Country:US
Practice Address - Phone:405-842-0745
Practice Address - Fax:405-842-6546
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100245670AMedicaid