Bridgeport Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0552382 Issued in WV

Legal business name

BRIDGEPORT PHARMACY INC

Practice address

200 Route 98 W St
Ste 105a
Nutter Fort, WV 26301-4385

Phone

(304) 624-0974

Fax

(304) 624-0979

NPI assigned

Nov 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Saad Mossallati

Title

Treasurer

Phone

(304) 623-5711

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medwood Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395014400000",
    "number": "1063667947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ROUTE 98 W ST",
            "address_2": "STE 105A",
            "city": "NUTTER FORT",
            "state": "WV",
            "postal_code": "263014385",
            "telephone_number": "304-624-0974",
            "fax_number": "304-624-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ROUTE 98 W ST",
            "address_2": "STE 105A",
            "city": "NUTTER FORT",
            "state": "WV",
            "postal_code": "263014385",
            "telephone_number": "304-624-0974",
            "fax_number": "304-624-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2014-03-17",
        "status": "A",
        "authorized_official_last_name": "MOSSALLATI",
        "authorized_official_first_name": "SAAD",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "304-623-5711"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2118653",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Nutter Fort, WV
• Providers in Nutter Fort, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.