Provider Demographics
NPI:1437294329
Name:PWP MEDICAL INC
Entity type:Organization
Organization Name:PWP MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREAST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-825-6331
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-0428
Mailing Address - Country:US
Mailing Address - Phone:252-825-7271
Mailing Address - Fax:252-825-2976
Practice Address - Street 1:7433 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812
Practice Address - Country:US
Practice Address - Phone:252-825-7271
Practice Address - Fax:252-825-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC081983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0745845Medicaid
2065186OtherPK
NC0745845Medicaid
NC0745845Medicaid