NPIMap

Organization Active NPI

Park West Pharmacy

  • Pharmacy
  • Little Rock, AR
National Provider Identifier
1053308940
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
69175 Issued in AR
Legal business name
PARK WEST PHARMACY
Practice address
904 Autumn Rd
Suite 275
Little Rock, AR 72211-3702
Phone
(501) 224-3499
Fax
(501) 224-1140
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bill Bloodworth
Title
Pharmacy Owner
Phone
(501) 224-3499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 69175 AR Primary

Addresses

Primary practice location

904 Autumn Rd
Suite 275
Little Rock, AR 72211-3702

Mailing address

904 Autumn Rd
Suite 275
Little Rock, AR 72211-3702
Phone (501) 224-3499

Other identifiers 1

IdentifierTypeStateIssuer
100701407MedicaidAR

National Provider Directory

National Provider Directory

Locations

904 Autumn Rd
Ste 275
Little Rock, AR 72211
Phone (501) 224-3499

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1053308940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD",
            "address_2": "SUITE 275",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113702",
            "telephone_number": "501-224-3499",
            "fax_number": "501-224-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD",
            "address_2": "SUITE 275",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113702",
            "telephone_number": "501-224-3499",
            "fax_number": "501-224-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK WEST PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "BLOODWORTH",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "PHARMACY OWNER",
        "authorized_official_telephone_number": "501-224-3499",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AR",
            "license": "69175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100701407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.