Provider Demographics
NPI:1710131081
Name:RWG CO INC
Entity Type:Organization
Organization Name:RWG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-239-6565
Mailing Address - Street 1:328 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-8129
Mailing Address - Country:US
Mailing Address - Phone:715-239-6565
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-8384
Practice Address - Country:US
Practice Address - Phone:715-239-6453
Practice Address - Fax:715-239-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6620-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33048700Medicaid
WI0941430001Medicare NSC