Active NPI
Lea Williamson Black, PHARMACIST
- Pharmacist
- Idabel, OK
National Provider Identifier
1669072047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11827
- Practice address
- 1907 SE Washington St
Idabel, OK 74745-5253 - Phone
- (580) 286-3323
- Fax
- (580) 286-2396
- NPI assigned
- Oct 27, 2020
- Last updated
- Oct 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11827 | OK | Primary |
Addresses
Primary practice location
1907 SE Washington St
Idabel, OK 74745-5253
Mailing address
3408 State Highway 37
Garvin, OK 74736-5314
Phone (580) 212-8678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11827 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Walmart Pharmacy 10-0038
- Community/Retail Pharmacy
- Idabel, OK
- NPI 1699792721
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1669072047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3408 STATE HIGHWAY 37",
"city": "GARVIN",
"state": "OK",
"postal_code": "747365314",
"telephone_number": "580-212-8678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1907 SE WASHINGTON ST",
"city": "IDABEL",
"state": "OK",
"postal_code": "747455253",
"telephone_number": "580-286-3323",
"fax_number": "580-286-2396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "LEA",
"middle_name": "WILLIAMSON",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "11827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idabel, OK
- Belmar Emergency Group, PC
- Belmar Physician Services, PC
- Courtney Billington
- Bio-Medical Applications of Oklahoma, Inc. (FMC Idabel Dialysis)
- Jamie Bivings, LCSW
- Amber Clarice Bond, WELLNESS COACH
- Mary L. Bradley-Leboeuf, M.D.
- Tammy Louise Bray-Wright, C-CHW/PRN
- Brighter Heights Oklahoma, LLC (Brighter Heights Oklahoma)
- Brighter Heights Oklahoma, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.