1679970354 NPI number — SLW & BCW ENTERPRISES, INC

Table of content: (NPI 1679970354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679970354 NPI number — SLW & BCW ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLW & BCW ENTERPRISES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARE-FILL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679970354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 MERCER RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16125-9773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-885-0310
Provider Business Mailing Address Fax Number:
724-373-8460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 WILLIAMSON RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16125-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-588-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WALBERG
Authorized Official First Name:
BRETTON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-612-2131

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1016735080 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2148962 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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