NPIMap

Organization Active NPI

Williams Pharmacy Holdings 1 LLC

  • Community/Retail Pharmacy
  • Moorefield, WV
National Provider Identifier
1104248269
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
SP055246 Issued in WV
Legal business name
WILLIAMS PHARMACY HOLDINGS 1 LLC
Practice address
732 N Main St
Moorefield, WV 26836-1021
Phone
(304) 530-1044
Fax
(304) 530-2681
NPI assigned
Jan 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Bradley Joseph Williams, PHARM.DNPI 1508287277
Title
Owner
Phone
(304) 530-1044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X SP055246 WV Primary

Addresses

Primary practice location

732 N Main St
Moorefield, WV 26836-1021

Mailing address

732 N Main St
Moorefield, WV 26836-1021
Phone (304) 530-1044

Other identifiers 2

IdentifierTypeStateIssuer
3910005593MedicaidWV
2144262OtherPK

Other names 1

  • South Fork Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

414 S Main St
Moorefield, WV 26836
Phone (304) 530-1044

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1104248269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 N MAIN ST",
            "city": "MOOREFIELD",
            "state": "WV",
            "postal_code": "268361021",
            "telephone_number": "304-530-1044",
            "fax_number": "304-530-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 N MAIN ST",
            "city": "MOOREFIELD",
            "state": "WV",
            "postal_code": "268361021",
            "telephone_number": "304-530-1044",
            "fax_number": "304-530-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS PHARMACY HOLDINGS 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-530-1044",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP055246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910005593",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144262",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Fork Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Fork Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moorefield, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.