NPIMap

Organization Active NPI

Victory Distributors LLC

  • Community/Retail Pharmacy
  • Norwell, MA
National Provider Identifier
1164530549
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
3405 Issued in MA
Legal business name
VICTORY DISTRIBUTORS LLC
Practice address
10 Washington St
Norwell, MA 02061-1749
Phone
(781) 878-7063
Fax
(718) 878-0311
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2016

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

Authorized official

Name
Elwen Eaton
Title
Pharmacy Insurance Specialist
Phone
(207) 885-7454

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 3405 MA Primary

Addresses

Primary practice location

10 Washington St
Norwell, MA 02061-1749

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2039545OtherPK
0497959MedicaidMA

Other names 1

  • Hannaford Supermarket & Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110207000024 MA Part B Supplier - Mass Immunization (Roster Biller Only) 3476764911 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chelmsford, MA; Dracut, MA; Waltham, MA
O20111006000438 MA Part B Supplier - Mass Immunization (Roster Biller Only) 3476764911 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leominster, MA; Lunenburg, MA; Middleboro, MA; N Brookfield, MA; Taunton, MA; Uxbridge, MA; Waltham, MA

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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": "1460678400000",
    "number": "1164530549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045005",
            "telephone_number": "207-885-7454",
            "fax_number": "207-885-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WASHINGTON ST",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "020611749",
            "telephone_number": "781-878-7063",
            "fax_number": "718-878-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DISTRIBUTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "ELWEN",
        "authorized_official_title_or_position": "PHARMACY INSURANCE SPECIALIST",
        "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": "MA",
            "license": "3405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2039545",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497959",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannaford Supermarket & Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwell, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; 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.