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General NPI Number Information
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NPI Number | 1386074946
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Entity Type | Organization
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Legal Business Name | NW BARTLESVILLE LLC
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 143 SE WASHINGTON BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2334
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Country | US
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Telephone | 918-876-4204
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Fax | 918-876-4206
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Provider Business Mailing Address
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Address Line | PO BOX 34407 PMB 53760
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City | LITTLE ROCK
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State | AR
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Zip | 72203-4407
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Country | US
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Telephone | 501-534-4459
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Fax | 501-534-4460
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Authorized Official
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Title or Position | PRESIDENT
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Name | UMAR FAROOQ
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Credential |
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Telephone | 501-392-8680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 9-6509
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License Number State | OK
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