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PARK WEST PHARMACY
NPI 1053308940
Pharmacy in Little Rock, AR

Active since October 05, 2005CLIA 04D2247630 · Waiver
904 AUTUMN RD, SUITE 275, LITTLE ROCK, AR 72211(501) 224-3499(501) 224-1140 Get Directions Write a Review

NPPES record last updated: September 12, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Park West Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK WEST PHARMACY (NPI 1053308940) is a healthcare organization registered as a pharmacy in Little Rock, Arkansas and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through January 6, 2028 and lists Bill Bloodworth, Pharmacy Owner, as its authorized official.

NPPES Registry Identity

NPI1053308940
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NamePARK WEST PHARMACY
Location Address904 AUTUMN RD, SUITE 275Little Rock, AR 72211-3702
Mailing Address904 Autumn Rd, Suite 275Little Rock, AR 72211-3702 · (501) 224-3499 · Fax (501) 224-1140
Phone(501) 224-3499
Fax(501) 224-1140
Organization SubpartNo
Authorized OfficialBill BloodworthPharmacy Owner · (501) 224-3499
Enumeration DateOctober 5, 2005
Last NPPES UpdateSeptember 12, 2012
✔ NPI 1053308940 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in AR · 69175
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
904 AUTUMN RD, Little Rock, AR 72211
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Other Identifiers 1

Medicaid100701407AR

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D2247630

Park West Pharmacy Dalton Herzig Inc · Little Rock, AR
Active · expires Jan 6, 2028
CLIA Number04D2247630
Laboratory TypePharmacy
Certificate Effective DateJanuary 7, 2026
Certificate Expiration DateJanuary 6, 2028
Laboratory DirectorJesse N. Pruitt
Laboratory Phone(501) 224-3499
Laboratory LocationPark West Pharmacy Dalton Herzig Inc904 Autumn Road Ste 275, Little Rock, AR 72211
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RICHARD ALLEN CALHOUN M. D.
Family Medicine
904 AUTUMN RD, SUITE 200
LITTLE ROCK, AR 72211
Pulaski County (501) 227-6363
JERRY DOUGLAS BYRUM MD
Pediatrics
904 AUTUMN RD, SUITE 100
LITTLE ROCK, AR 72211
Pulaski County (501) 224-5437
ARKANSAS HEALTH GROUP
Preferred Provider Organization
904 AUTUMN RD, SUITE 100
LITTLE ROCK, AR 72211
Pulaski County (501) 224-5437
THOMAS PAULUS M.D.
Pediatrics
904 AUTUMN RD, SUITE 100
LITTLE ROCK, AR 72211
Pulaski County (501) 224-5437
ANDREW JACK SOMERS M.D.
Family Medicine
904 AUTUMN RD, SUITE 200
LITTLE ROCK, AR 72211
Pulaski County (501) 227-6363
JOHN PHILIP POUNDERS JR. M.D.
Family Medicine
904 AUTUMN RD, SUITE 200
LITTLE ROCK, AR 72211
Pulaski County (501) 227-6363
KIMBERLY SKELLEY MD
Pediatrics
904 AUTUMN RD, SUITE 100
LITTLE ROCK, AR 72211
Pulaski County (501) 224-5437
WILLIAM DAVID KING M.D.
Family Medicine
904 AUTUMN RD, SUITE 200
LITTLE ROCK, AR 72211
Pulaski County (501) 227-6363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park West Pharmacy's NPI number?

The NPI number for Park West Pharmacy is 1053308940. It was assigned to this organization in the NPPES registry on October 5, 2005.

Where is Park West Pharmacy located?

Park West Pharmacy is located at 904 Autumn Rd Suite 275, Little Rock, AR 72211. The listed phone number is (501) 224-3499.

What is Park West Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Park West Pharmacy hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D2247630) is associated with this NPI, valid through January 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Park West Pharmacy was last updated on September 12, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.