NPIMap

Organization Active NPI

Victory Distributors, LLC

Doing business as Hannaford Food & Drug #8192

  • Community/Retail Pharmacy
  • Dracut, MA
National Provider Identifier
1316170442
Registry record updated Nov 18, 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 #8192
Practice address
301 Pleasant St
Dracut, MA 01826-4909
Phone
(978) 452-5255
Fax
(978) 459-8433
NPI assigned
Aug 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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 2697 MA
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

301 Pleasant St
Dracut, MA 01826-4909

Mailing address

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

Other names 1

  • Hannaford Food & Drug #8192 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930023325 MA DME Supplier - PharmacyDME Supplier - Grocery Store 3476764911 Practice locations: Dracut, MA
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

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

Member of 1

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

Locations

301 Pleasant St
Dracut, MA 01826
Phone (978) 452-5255

NPI Registry JSON

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

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1316170442",
    "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": "207-396-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PLEASANT ST",
            "city": "DRACUT",
            "state": "MA",
            "postal_code": "018264909",
            "telephone_number": "978-452-5255",
            "fax_number": "978-459-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DISTRIBUTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2014-11-18",
        "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": "2697",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannaford Food & Drug #8192",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dracut, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.