Willo Group

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0552461 Issued in WV

Legal business name

WILLO GROUP

Doing business as

Bridgeport Family Pharmacy

Practice address

460 E. Main Street
Bridgeport, WV 26330

Phone

(304) 848-9500

Fax

(304) 848-9503

NPI assigned

Dec 10, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Lori R Spatafore, RPHNPI 1235718214

Title

Owner/Member

Phone

(304) 848-9500

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Bridgeport Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

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

• Lori Spatafore, RPH

  • Pharmacist
  • Bridgeport, WV
  • NPI 1235718214
  NPD Authorized official

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1396176756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 E. MAIN STREET",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "26330",
            "telephone_number": "304-848-9500",
            "fax_number": "304-848-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 E. MAIN STREET",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "26330",
            "telephone_number": "304-848-9500",
            "fax_number": "304-848-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLO GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "SPATAFORE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "304-848-9500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0552461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143725",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910001300",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeport Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bridgeport Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Destiny D Williams, FNP-BC
• Junemarie Williams, APRN-FNP-BC
• Mary Kristi Williams, M.A.
• Regina Ann Williams, LPC
• Hillary Beth Williamson, DDS
• Jessica Elizabeth Willoughby, MOT, OTR/L
• Catherine Alexis Wilson
• Kaitlyn Wilson
• Leslie P Wolford, DMD, MS.
• Susan Michelle Wood, MOTR/L

• Community/Retail Pharmacy in Bridgeport, WV
• Providers in Bridgeport, 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 Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.