OrganizationNorthwest Pharmacy, IncDurable Medical Equipment & Medical SuppliesSuppliersPractice Address2210 Barron Rd, Poplar Bluff, MO 63901-1908(573) 686-6211PECOS EnrollmentBased on the most recent information from CMS, provider Northwest Pharmacy, Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1245364066Provider TypeOrganizationFull NameNorthwest Pharmacy, IncSubpartNoEnumeration Date3/15/2007Last Updated3/7/2023Contact InformationPractice LocationPractice Address2210 Barron Rd, Poplar Bluff, MO 63901-1908Phone(573) 686-6211Fax(573) 686-2219Mailing LocationMailing Address2210 Barron Rd, Poplar Bluff, MO 63901-1908Phone(573) 686-6211Fax(573) 686-2219Authorized OfficialNameKleinbeck, Mark T (President)Phone(573) 686-6211Provider TaxonomiesCodeDescriptionLicenseCode332B00000XPrimaryDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicense620059725MissouriProvider IdentifiersIDDescriptionIssuerID620059725DescriptionMedicaidIssuerUnlistedMissouriID1902974140DescriptionOtherIssuerRX NPIMissouriID2004019998DescriptionOtherIssuerMO PHARMACY PERMITMissouri