Organization
NW COWETA LLC
Active
Other names
Express Rx of Coweta
Organization subpart
No
Provider details
NPI number
Authorized official
UMAR FAROOQ (PRESIDENT)
(501) 392-8680
Entity
Organization
Contact information
Practice address
12071 S STATE HIGHWAY 51, COWETA, OK 74429-7136
(918) 887-1040
(918) 279-0152
Mailing address
PO BOX 7791, LITTLE ROCK, AR 72217-7791
(855) 553-9777
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
38-7749
OK
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200686020A
—
OK
01
—
2164371
PK
—
Enumeration date
09/14/2016
Last updated
11/18/2025
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