MEDICARE: BW ONE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY53655	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2126411	OTHER		PK

General Provider Information

NPI Number	:	1447243324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BW ONE INC

Provider Business Mailing Address
First Line	:	656 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2801
Country	:	US
Telephone Number	:	213-617-7888
Fax Number	:	213-617-7241

Provider Business Practice Location Address
First Line	:	656 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2802
Country	:	US
Telephone Number	:	213-617-7888
Fax Number	:	213-617-7241

Authorized Official
Title or Position	:	PHARMD
Name	:	BRIAN WU
Credential	:
Telephone Number	:	213-617-7888

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/19/2018

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Directions to “BW ONE INC ” Practice Location

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