NPIMap

Organization Active NPI

Victory Distributors, LLC

Doing business as Hannaford Food & Drug #8383

  • Community/Retail Pharmacy
  • Taunton, MA
National Provider Identifier
1245463876
Registry record updated Jan 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
VICTORY DISTRIBUTORS, LLC
Doing business as
Hannaford Food & Drug #8383
Practice address
255 Joseph E. Warner Blvd
Taunton, MA 02780
Phone
(580) 824-1057
Fax
(508) 822-0140
NPI assigned
Aug 31, 2009
Last updated
Jan 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2014

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

Authorized official

Name
Elwen EatonNPI 1063827376
Title
Pharmacy Insurance Specialist
Phone
(207) 885-7454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 3439 MA
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

255 Joseph E. Warner Blvd
Taunton, MA 02780

Mailing address

PO Box 1000
Ms3000
Portland, ME 04104-5005
Phone (207) 885-7454

Other names 1

  • Hannaford Food & Drug #8383 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930049011 MA DME Supplier - PharmacyDME Supplier - Grocery Store 3476764911 Practice locations: Taunton, 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 with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Victory Distributors LLC27 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

Member of 1

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

Locations

255 Warner Blvd
Taunton, MA 02780
Phone (508) 824-1057

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1245463876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "address_2": "MS3000",
            "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": "255 JOSEPH E. WARNER BLVD",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "02780",
            "telephone_number": "580-824-1057",
            "fax_number": "508-822-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DISTRIBUTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2014-01-27",
        "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": "MA",
            "license": "3439",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannaford Food & Drug #8383",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taunton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; 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.