| NPI | 1104248269 |
|---|---|
| Doing Business As | SOUTH FORK PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BRADLEY JOSEPH WILLIAMS Owner 304-530-1044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WV SP055246) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2020-12-03 |