Organization
BRIDGEPORT PRESCRIPTION SHOP LLC
Active
Other names
COMMUNITY PHARMACY OF BRIDGEPORT
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J RAVIS PHARM D (PIC/OWNER)
(304) 695-0572
Entity
Organization
Contact information
Practice address
1212 JOHNSON AVE, BRIDGEPORT, WV 26330-1354
(304) 842-3223
Mailing address
1212 JOHNSON AVE, BRIDGEPORT, WV 26330-1354
(304) 842-3223
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
WV
Other
Enumeration date
03/05/2014
Last updated
03/05/2014
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