Victapharm

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

VICTAPHARM

Practice address

110 Elmwood Ave
Providence, RI 02907-2423

Phone

(401) 300-5757

NPI assigned

Dec 8, 2021

Organization subpart

Yes

Parent organization

VICTA LLCAs reported in NPPES

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

Authorized official

Name

Lisa A Peterson

Title

Chief Operating Officer

Phone

(401) 432-6029

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Victa LLC2 organizations share this tax ID, including this one

Part of

Victa LLC

Other organizations with this tax ID 1

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

• Victa LLC

  • Methadone Clinic
  • Providence, RI
  • NPI 1457822413
  NPD tax ID

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

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1265191118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072423",
            "telephone_number": "401-300-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072423",
            "telephone_number": "401-300-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTAPHARM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VICTA LLC",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "401-432-6029"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104317007",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@hushmail.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "110 Elmwood Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029072423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paige Alexis Vetrano, PA-C
• Laura Gibbs Veyera, LICSW
• Michael P Vezeridis, MD
• Victa LLC
• Victa LLC
• Victoria Sokolowski, LLC
• Sandra Victorino, LMHC
• Megan Tatiana Vidal, MD
• Tatiana Vidal
• Colette S. Vieau, M. D.

• Pharmacy in Providence, RI
• Providers in Providence, RI by specialty
• Pharmacy in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; 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.