Provider Demographics
NPI:1679970354
Name:SLW & BCW ENTERPRISES, INC
Entity type:Organization
Organization Name:SLW & BCW ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-612-2131
Mailing Address - Street 1:343 MERCER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-9773
Mailing Address - Country:US
Mailing Address - Phone:724-885-0310
Mailing Address - Fax:724-373-8460
Practice Address - Street 1:43 WILLIAMSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1224
Practice Address - Country:US
Practice Address - Phone:724-588-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
PAPP413647L3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016735080Medicaid
2148962OtherPK
PA1016735080Medicaid