NPIMap

Organization Active NPI

Victory Distributors LLC

Doing business as Hannaford Supermarket & Pharmacy

  • Community/Retail Pharmacy
  • Kingston, MA
National Provider Identifier
1255449633
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
3404 Issued in MA
Legal business name
VICTORY DISTRIBUTORS LLC
Doing business as
Hannaford Supermarket & Pharmacy
Practice address
182 Summer St
Kingston, MA 02364-1277
Phone
(781) 585-1326
Fax
(781) 585-1310
NPI assigned
Aug 27, 2006
Last updated
Apr 15, 2016By the provider in NPPES
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 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 NU
Community/Retail Pharmacy 3336C0003X 3404 MA Primary

Addresses

Primary practice location

182 Summer St
Kingston, MA 02364-1277

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0497789MedicaidMA
2039544OtherPK

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.

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": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1255449633",
    "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": "182 SUMMER ST",
            "city": "KINGSTON",
            "state": "MA",
            "postal_code": "023641277",
            "telephone_number": "781-585-1326",
            "fax_number": "781-585-1310"
        }
    ],
    "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MA",
            "license": "3404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0497789",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2039544",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannaford Supermarket & Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingston, 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.