Provider Demographics
NPI:1760493431
Name:B L W INC
Entity Type:Organization
Organization Name:B L W INC
Other - Org Name:HOMETOWN DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDAZONA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-475-2142
Mailing Address - Street 1:65 NE OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1814
Mailing Address - Country:US
Mailing Address - Phone:541-475-2142
Mailing Address - Fax:541-475-6244
Practice Address - Street 1:65 NE OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1814
Practice Address - Country:US
Practice Address - Phone:541-475-2142
Practice Address - Fax:541-475-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1835P0018X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336I0012X, 3336L0003X
ORRP0000292CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR293105Medicaid
2077338OtherPK
OR194373Medicaid
0896500001Medicare NSC