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General NPI Number Information
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NPI Number | 1053308940
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Entity Type | Organization
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Legal Business Name | PARK WEST PHARMACY
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 904 AUTUMN RD SUITE 275
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3702
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Country | US
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Telephone | 501-224-3499
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Fax | 501-224-1140
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Provider Business Mailing Address
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Address Line | 904 AUTUMN RD SUITE 275
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3702
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Country | US
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Telephone | 501-224-3499
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Fax | 501-224-1140
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | DR. BILL BLOODWORTH
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Credential |
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Telephone | 501-224-3499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 69175
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License Number State | AR
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