Healthcare Provider Details

I. General information

NPI: 1023330073
Provider Name (Legal Business Name): BW ONE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N BROADWAY
LOS ANGELES CA
90012-2801
US

IV. Provider business mailing address

655 N BROADWAY
LOS ANGELES CA
90012-2801
US

V. Phone/Fax

Practice location:
  • Phone: 626-617-7888
  • Fax: 213-617-7887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PAK WU
Title or Position: CEO
Credential: PHARM.D.
Phone: 213-617-7888