Healthcare Provider Details

I. General information

NPI: 1134285737
Provider Name (Legal Business Name): GWM ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 ACADEMY ST S
AHOSKIE NC
27910-3200
US

IV. Provider business mailing address

107 SMITH CHURCH RD
ROANOKE RAPIDS NC
27870-4911
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-4101
  • Fax:
Mailing address:
  • Phone: 252-537-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7755
License Number StateNC

VIII. Authorized Official

Name: LOUIS V MANN III
Title or Position: VP OPERATIONS
Credential:
Phone: 252-537-7010