MEDICARE: NW BARTLESVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	9-6509	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144292	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386074946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NW BARTLESVILLE LLC

Provider Business Mailing Address
First Line	:	PO BOX 34407
Second Line	:	PMB 53760
City	:	LITTLE ROCK
State	:	AR
Zip	:	72203-4407
Country	:	US
Telephone Number	:	501-534-4459
Fax Number	:	501-534-4460

Provider Business Practice Location Address
First Line	:	143 SE WASHINGTON BLVD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2334
Country	:	US
Telephone Number	:	918-876-4204
Fax Number	:	918-876-4206

Authorized Official
Title or Position	:	PRESIDENT
Name	:	UMAR FAROOQ
Credential	:
Telephone Number	:	501-392-8680

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/18/2025

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Directions to “NW BARTLESVILLE LLC ” Practice Location

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