Provider Demographics
NPI:1942592985
Name:BWWNGC, INC
Entity Type:Organization
Organization Name:BWWNGC, INC
Other - Org Name:BURNS DRUGS AND HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-459-4285
Mailing Address - Street 1:2707 VIA DE LA VALLE
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1905
Mailing Address - Country:US
Mailing Address - Phone:858-481-4029
Mailing Address - Fax:858-755-3050
Practice Address - Street 1:2707 VIA DE LA VALLE
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1905
Practice Address - Country:US
Practice Address - Phone:858-481-4029
Practice Address - Fax:858-755-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350763336C0003X
CAPHY370183336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD613AOtherCALIFORNIA FLU