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Organization
JWWG INC
Active
Organization
JWWG INC
Active
Other names
Country Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER W GODFREY SR. PHARMACIST (OWNER/MANAGER)
(717) 768-2000
Entity
Organization
Contact information
Practice address
14 D CENTER ST, INTERCOURSE, PA 17534
(717) 768-2000
(717) 768-3333
Mailing address
PO BOX 57, 14D CENTER ST, INTERCOURSE, PA 17534-0057
(717) 768-2000
(717) 768-3333
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PP481436
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0398419
PACE
PA
05
—
1012843030001
—
PA
Enumeration date
10/07/2005
Last updated
08/22/2020
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