Organization
WILLO GROUP
Active
Other names
Bridgeport Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI R SPATAFORE RPH (OWNER/MEMBER)
(304) 848-9500
Entity
Organization
Contact information
Practice address
460 E. MAIN STREET, BRIDGEPORT, WV 26330
(304) 848-9500
(304) 848-9503
Mailing address
460 E. MAIN STREET, BRIDGEPORT, WV 26330
(304) 848-9500
(304) 848-9503
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552461
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143725
PK
—
05
—
3910001300
—
WV
Enumeration date
12/10/2013
Last updated
04/30/2021
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