Provider Demographics
NPI:1134285737
Name:GWM ENTERPRISES
Entity Type:Organization
Organization Name:GWM ENTERPRISES
Other - Org Name:DRUGCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:MANN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:252-537-7010
Mailing Address - Street 1:107 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4911
Mailing Address - Country:US
Mailing Address - Phone:252-537-7010
Mailing Address - Fax:
Practice Address - Street 1:312 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3200
Practice Address - Country:US
Practice Address - Phone:252-332-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3438721OtherNABP
NC0465252Medicaid