NPIMap

Organization Active NPI

Dalton Herzig, Inc.

Doing business as Park West Pharmacy

  • Community/Retail Pharmacy
  • Little Rock, AR
National Provider Identifier
1750934287
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
DALTON HERZIG, INC.
Doing business as
Park West Pharmacy
Practice address
904 Autumn Rd Ste 275
Little Rock, AR 72211-3745
Phone
(501) 224-3499
NPI assigned
Jul 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Mrs. Gwendolyn HerzigNPI 1255998514
Title
Owner
Phone
(501) 224-3499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

904 Autumn Rd Ste 275
Little Rock, AR 72211-3745

Mailing address

904 Autumn Rd Ste 275
Little Rock, AR 72211-3745
Phone (501) 224-3499

Other names 1

  • Park West Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217001078 AR Part B Supplier - Pharmacy 9133534522 Practice locations: Little Rock, AR

National Provider Directory

National Provider Directory

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": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1750934287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD STE 275",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113745",
            "telephone_number": "501-224-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 AUTUMN RD STE 275",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113745",
            "telephone_number": "501-224-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALTON HERZIG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "HERZIG",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-224-3499",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park West Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park West Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.