Provider Demographics
NPI:1225499619
Name:NW CABOT LLC
Entity Type:Organization
Organization Name:NW CABOT LLC
Other - Org Name:EXPRESS RX OF CABOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-640-9270
Mailing Address - Street 1:PO BOX 34407
Mailing Address - Street 2:PMB 53760
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-4407
Mailing Address - Country:US
Mailing Address - Phone:501-534-4459
Mailing Address - Fax:
Practice Address - Street 1:1848 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2745
Practice Address - Country:US
Practice Address - Phone:855-553-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
ARAR208353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159242OtherPK
AR214793407Medicaid