Healthcare Provider Details

I. General information

NPI: 1013108893
Provider Name (Legal Business Name): BWE & TME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W WASHINGTON ST
MILLSTADT IL
62260-1156
US

IV. Provider business mailing address

120 W WASHINGTON ST
MILLSTADT IL
62260-1156
US

V. Phone/Fax

Practice location:
  • Phone: 618-476-1701
  • Fax: 618-476-1709
Mailing address:
  • Phone: 618-476-1701
  • Fax: 618-476-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016160
License Number StateIL

VIII. Authorized Official

Name: WILLIAM WHITWORTH
Title or Position: OWNER
Credential: RPH
Phone: 618-343-2525