Organization
BRIDGEPORT PHARMACY INC
Active
Other names
Medwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SAAD MOSSALLATI (TREASURER)
(304) 623-5711
Entity
Organization
Contact information
Practice address
200 ROUTE 98 W ST, STE 105A, NUTTER FORT, WV 26301-4385
(304) 624-0974
(304) 624-0979
Mailing address
200 ROUTE 98 W ST, STE 105A, NUTTER FORT, WV 26301-4385
(304) 624-0974
(304) 624-0979
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
SP0552382
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118653
PK
—
Enumeration date
11/19/2008
Last updated
03/17/2014
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