NPIMap

Organization Active NPI

Victory Distributors LLC

  • Community/Retail Pharmacy
  • Manchester, NH
National Provider Identifier
1063520443
Registry record updated Apr 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0366 Issued in NH
Legal business name
VICTORY DISTRIBUTORS LLC
Practice address
201 John Devine Dr
Manchester, NH 03103
Phone
(603) 626-1233
Fax
(603) 626-3002
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2018

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

Authorized official

Name
Michael Vail
Title
President and Manager
Phone
(207) 885-7454

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 0366 NH Primary

Addresses

Primary practice location

201 John Devine Dr
Manchester, NH 03103

Mailing address

PO Box 1000
Ms 3000
Portland, ME 04104-5005
Phone (207) 885-7454

Other identifiers 3

IdentifierTypeStateIssuer
2053050OtherPK
3080814MedicaidNH
30005022MedicaidNH

National Provider Directory

National Provider Directory
Tax ID family
Victory Distributors Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1063520443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "address_2": "MS 3000",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045005",
            "telephone_number": "207-885-7454",
            "fax_number": "704-645-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 JOHN DEVINE DR",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "03103",
            "telephone_number": "603-626-1233",
            "fax_number": "603-626-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DISTRIBUTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "VAIL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT AND MANAGER",
        "authorized_official_telephone_number": "207-885-7454"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NH",
            "license": "0366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2053050",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3080814",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30005022",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; 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.