Healthcare Provider Details

I. General information

NPI: 1225499619
Provider Name (Legal Business Name): NW CABOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 W MAIN ST STE B
CABOT AR
72023-2745
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203-4407
US

V. Phone/Fax

Practice location:
  • Phone: 855-553-9777
  • Fax:
Mailing address:
  • Phone: 501-534-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20835
License Number StateAR

VIII. Authorized Official

Name: UMAR FAROOQ
Title or Position: PRESIDENT
Credential:
Phone: 501-392-8680