Victory RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

030142 Issued in NY

Legal business name

VICTORY RX LLC

Doing business as

Randall Manor Pharmacy & Surgicals

Practice address

395 Forest Ave
Staten Island, NY 10301-2622

Phone

(718) 720-2324

Fax

(718) 720-2327

NPI assigned

Mar 16, 2010

Last updated

Nov 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicholas Amaxas, RPHNPI 1346564630

Title

Pharmacist/Owner

Phone

(718) 720-2324

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• RANDALL MANOR PHARMACY & SURGICALS Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas Amaxas, RPH

  • Pharmacist
  • Staten Island, NY
  • NPI 1346564630
  NPD Authorized official
• Motunrayo Ogunjemilusi, PHARMACIST

  • Pharmacist
  • Staten Island, NY
  • NPI 1447772462
  NPD (past)

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

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1023332319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012622",
            "telephone_number": "718-720-2324",
            "fax_number": "718-720-2327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012622",
            "telephone_number": "718-720-2324",
            "fax_number": "718-720-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "AMAXAS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "718-720-2324",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3249612",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125564",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RANDALL MANOR PHARMACY & SURGICALS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Victory Physical Therapy, P.C.
• Victory Podiatry Associate PLLC
• Victory RX Pharma Inc
• Victoryendoscopyunit,PLLC
• Michele Ann Vigeant, LMHC
• Micaela Viggiano, BSW
• Lauren Vigilante, LMSW

• Community/Retail Pharmacy in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.