Healthcare Provider Details

I. General information

NPI: 1134262629
Provider Name (Legal Business Name): SLW & BCW ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 KINSMAN-NICKERSON RD
KINSMAN OH
44428
US

IV. Provider business mailing address

PO BOX 395
KINSMAN OH
44428-0395
US

V. Phone/Fax

Practice location:
  • Phone: 330-876-0004
  • Fax: 330-876-0195
Mailing address:
  • Phone:
  • Fax:

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 Number021355800
License Number StateOH

VIII. Authorized Official

Name: BRETTON WALBERG
Title or Position: OWNER
Credential: RPH
Phone: 724-612-2131