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NW OTTER CREEK LLC NPI 1285167502


NPI Information

NPI: 1285167502
Provider Name: NW OTTER CREEK LLC

Doing Business As: EXPRESS RX AT OTTER CREEK

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 04D2144468

Address:
10100 STAGECOACH RD
LITTLE ROCK, AR
ZIP 72210
Phone: (501) 455-2522
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NW OTTER CREEK LLC is a community/retail pharmacy pharmacy in Little Rock, AR. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. NW OTTER CREEK LLC NPI is 1285167502. The provider is registered as an organization entity type.
The provider Is Doing Business As Express Rx At Otter Creek.

The provider's business location address is:

10100 STAGECOACH RD
LITTLE ROCK, AR
ZIP 72210-742
Phone: (501) 455-2522

The provider's authorized official is John Trainor Namir .
The authorized official title is Cfo and has the following contact phone number (501) 773-0359.

The CLIA number assigned to this NPI record is 04D2144468 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2017 and was last updated on 5/21/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1221379407MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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