Active NPI
Dominique Leon Williams
- Pharmacist
- Edmond, OK
National Provider Identifier
1922722818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19847
- Practice address
- 17850 N Pennsylvania Ave
Edmond, OK 73012-9101 - Phone
- (405) 341-1142
- NPI assigned
- Oct 3, 2022
- Last updated
- Oct 3, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 19847 | OK | Primary |
Addresses
Primary practice location
17850 N Pennsylvania Ave
Edmond, OK 73012-9101
Mailing address
16925 Sunny Hollow Rd
Edmond, OK 73012-6740
Phone (405) 630-9502
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients | |
| Oklahoma CVS Pharmacy LLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664755200000",
"number": "1922722818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16925 SUNNY HOLLOW RD",
"city": "EDMOND",
"state": "OK",
"postal_code": "730126740",
"telephone_number": "405-630-9502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17850 N PENNSYLVANIA AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730129101",
"telephone_number": "405-341-1142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "DOMINIQUE",
"middle_name": "LEON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-03",
"last_updated": "2022-10-03",
"certification_date": "2022-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "19847",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.