Healthcare Provider Details

I. General information

NPI: 1578310967
Provider Name (Legal Business Name): VICTORIA SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6344 N WASHTENAW AVE APT 2
CHICAGO IL
60659-1710
US

IV. Provider business mailing address

6344 N WASHTENAW AVE APT 2
CHICAGO IL
60659-1710
US

V. Phone/Fax

Practice location:
  • Phone: 779-713-3759
  • Fax:
Mailing address:
  • Phone: 779-713-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAHANGEER SYED
Title or Position: CEO
Credential:
Phone: 779-713-3759