Active NPI
Victory Distributors, LLC
- Community/Retail Pharmacy
- South Easton, MA
National Provider Identifier
1396978433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- VICTORY DISTRIBUTORS, LLC
- Practice address
- 25 Robert Dr
South Easton, MA 02375-1356 - Phone
- (508) 238-4067
- Fax
- (508) 238-6153
- NPI assigned
- Aug 24, 2009
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 3438 | MA | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
25 Robert Dr
South Easton, MA 02375-1356
Mailing address
PO Box 1000
Ms3000
Portland, ME 04104-5005
Phone (207) 885-7454
Other names 1
- Hannaford Food & Drug #8382
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 11
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
25 Robert Dr
South Easton, MA 02375
Phone (508) 238-4067
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": "1390780800000",
"number": "1396978433",
"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": "25 ROBERT DR",
"city": "SOUTH EASTON",
"state": "MA",
"postal_code": "023751356",
"telephone_number": "508-238-4067",
"fax_number": "508-238-6153"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VICTORY DISTRIBUTORS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-08-24",
"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": "3438",
"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 #8382",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in South Easton, 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.