Provider Demographics
NPI:1932402336
Name:RW GROUP INC
Entity Type:Organization
Organization Name:RW GROUP INC
Other - Org Name:BEACON MEDICATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:860-583-1006
Mailing Address - Street 1:25 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6313
Mailing Address - Country:US
Mailing Address - Phone:860-582-4847
Mailing Address - Fax:860-584-9718
Practice Address - Street 1:25 MELLEN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6313
Practice Address - Country:US
Practice Address - Phone:860-582-4847
Practice Address - Fax:860-584-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY00021953336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127965OtherPK
CT008032955Medicaid