Provider Demographics
NPI:1275834780
Name:BEST CARE PHARMACY OF BRIDGEPORT, LLC
Entity Type:Organization
Organization Name:BEST CARE PHARMACY OF BRIDGEPORT, LLC
Other - Org Name:BEST CARE PHARMACY OF BRIDGEPORT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-848-7880
Mailing Address - Street 1:129 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1706
Mailing Address - Country:US
Mailing Address - Phone:304-848-7880
Mailing Address - Fax:304-848-7882
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1706
Practice Address - Country:US
Practice Address - Phone:304-848-7880
Practice Address - Fax:304-848-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WV05523913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127606OtherPK