Healthcare Provider Details

I. General information

NPI: 1487098448
Provider Name (Legal Business Name): NW CARTHAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MISSOURI AVE
CARTHAGE MO
64836-3060
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 417-359-8185
  • Fax: 417-359-8276
Mailing address:
  • Phone: 501-534-4459
  • Fax: 501-534-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2013012689
License Number StateMO

VIII. Authorized Official

Name: GALEN PERKINS
Title or Position: CEO
Credential:
Phone: 501-258-4399