Provider Demographics
NPI:1386159986
Name:WILLAYI, NULLACIA (BSN, PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:NULLACIA
Middle Name:
Last Name:WILLAYI
Suffix:
Gender:F
Credentials:BSN, PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S STRONG BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4431
Mailing Address - Country:US
Mailing Address - Phone:918-302-0566
Mailing Address - Fax:918-302-0708
Practice Address - Street 1:21 S STRONG BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4431
Practice Address - Country:US
Practice Address - Phone:918-302-0566
Practice Address - Fax:918-302-0708
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty