Provider Demographics
NPI:1124758834
Name:A W WHOLESALERS
Entity type:Organization
Organization Name:A W WHOLESALERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREO
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-515-1805
Mailing Address - Street 1:161 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:DRAKES BRANCH
Mailing Address - State:VA
Mailing Address - Zip Code:23937-2508
Mailing Address - Country:US
Mailing Address - Phone:434-262-3046
Mailing Address - Fax:434-226-8104
Practice Address - Street 1:161 ROSE LN
Practice Address - Street 2:
Practice Address - City:DRAKES BRANCH
Practice Address - State:VA
Practice Address - Zip Code:23937-2508
Practice Address - Country:US
Practice Address - Phone:434-262-3046
Practice Address - Fax:434-226-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child