Provider Demographics
NPI:1194713883
Name:JWWG INC
Entity type:Organization
Organization Name:JWWG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:717-768-2000
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:14D CENTER ST
Mailing Address - City:INTERCOURSE
Mailing Address - State:PA
Mailing Address - Zip Code:17534-0057
Mailing Address - Country:US
Mailing Address - Phone:717-768-2000
Mailing Address - Fax:717-768-3333
Practice Address - Street 1:14 D CENTER ST
Practice Address - Street 2:
Practice Address - City:INTERCOURSE
Practice Address - State:PA
Practice Address - Zip Code:17534
Practice Address - Country:US
Practice Address - Phone:717-768-2000
Practice Address - Fax:717-768-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0398419OtherPACE
PA1012843030001Medicaid