Healthcare Provider Details

I. General information

NPI: 1710131081
Provider Name (Legal Business Name): RWG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
CORNELL WI
54732-8384
US

IV. Provider business mailing address

328 N 6TH ST
CORNELL WI
54732-8129
US

V. Phone/Fax

Practice location:
  • Phone: 715-239-6453
  • Fax: 715-239-6078
Mailing address:
  • Phone: 715-239-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6620-042
License Number StateWI

VIII. Authorized Official

Name: RAY W. GAVITT
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 715-239-6565