Healthcare Provider Details

I. General information

NPI: 1801968698
Provider Name (Legal Business Name): BW II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 CLEVELAND RD
CLAYTON NC
27520-3676
US

IV. Provider business mailing address

9197 CLEVELAND RD
CLAYTON NC
27520-3676
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-6902
  • Fax: 919-772-9025
Mailing address:
  • Phone: 919-772-6902
  • Fax: 919-772-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7696
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LANCE WHEELER
Title or Position: MANAGER/MEMBER
Credential:
Phone: 919-772-6902