Organization
WILLIAMS PHARMACY HOLDINGS 1 LLC
Active
Other names
South Fork Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY JOSEPH WILLIAMS PHARM.D (OWNER)
(304) 530-1044
Entity
Organization
Contact information
Practice address
732 N MAIN ST, MOOREFIELD, WV 26836-1021
(304) 530-1044
(304) 530-2681
Mailing address
732 N MAIN ST, MOOREFIELD, WV 26836-1021
(304) 530-1044
(304) 530-2681
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP055246
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144262
PK
—
05
—
3910005593
—
WV
Enumeration date
01/09/2014
Last updated
12/03/2020
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