Provider Demographics
NPI:1801968698
Name:BW II LLC
Entity type:Organization
Organization Name:BW II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-772-6902
Mailing Address - Street 1:127 MAST DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6718
Mailing Address - Country:US
Mailing Address - Phone:919-772-6902
Mailing Address - Fax:919-772-9025
Practice Address - Street 1:127 MAST DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6718
Practice Address - Country:US
Practice Address - Phone:919-772-6902
Practice Address - Fax:919-772-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7696333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920175Medicaid
NC2801141OtherMEDICARE RAILROAD #
3438288OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NCBM7040265OtherDEA #
NC2801141Medicare PIN
3438288OtherOTHER ID NUMBER-COMMERCIAL NUMBER